Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

CABINET OFFICE

The Minister was asked—

Correspondence

Mr. Harry Barnes: If she will make it her policy that all Government Departments and agencies make use of constituents' postcodes in correspondence with hon. Members and others. [148766]

The Parliamentary Secretary, Cabinet Office (Mr. Graham Stringer): It is general practice for constituents' full addresses, including the postal code, to be included in ministerial replies to Members of Parliament. It is not, however, in the guide to Departments issued by the Cabinet Office for replies to MPs' letters.

Mr. Barnes: It is not my experience that the postcode is included. If a constituent writes to me from the S45 postcode area, complaining about the loss of 700 jobs at Biwater in Clay Cross, I forward that to the Department of Trade and Industry, seeking a response. Normally, however, the reply from a Department gives the full name and address but not the postcode details. It is administratively convenient to give the postcode details. I hope that that will be put in place. I would much sooner have the jobs, but will settle, on this occasion, for the postcode details.

Mr. Stringer: I take my hon. Friend's point. When we re-issue the guide to Ministers replying to letters sent to Members of Parliament, we shall include the point that postal codes should be included.

Mrs. Virginia Bottomley: Will the hon. Gentleman examine not only the postcode issue but an extraordinary development that has taken place since the last election? MPs' letters are often replied to at their constituency office. I regard in my work as a Member of Parliament as separate from my work as a Conservative based in the constituency office. To an extraordinary extent, more and more letters are returned to the constituency office, not to the House of Commons. I regard the roles as a little different.

Mr. Stringer: I shall certainly look into the point that the right hon. Lady raises. My expectation is that letters are returned to the Member of Parliament at the address that was on the original letter. However, if that is not the case, I shall look into the matter and ensure that it is considered when the next guide is issued.

Commonwealth Games

Mr. John Grogan: If she will make a statement on preparations for the Commonwealth games. [148768]

The Minister of State, Cabinet Office (Mr. Ian McCartney): I am pleased to say that Manchester 2002 is on target with plans and preparations to host the biggest sporting and cultural celebration ever held in the United Kingdom.
The sports programme has been finalised, and will be the largest ever for a Commonwealth games, with 14 individual and three team sports. Six new venues are being provided for the games, with improvements made to others. The £32 million aquatic centre was opened in October last year, the Bolton arena is nearing completion and is expected to open later this month, and work on the City of Manchester stadium is on target, with completion scheduled for December 2001. Some £18 million of commercial income has been announced and a further sponsorship announcement is expected later this month.

Mr. Grogan: I thank my right hon. Friend for that reply. As a proud Yorkshireman, it is rare for me to wish any event in Manchester well. On this occasion, however, will my right hon. Friend do everything possible to ensure that the games, which will occur in jubilee year, are promoted not just in the north-west but throughout the United Kingdom, so that they will be as inspirational for our sportsmen, sportswomen and youngsters as the Sydney Olympics were in Australia?

Mr. McCartney: My hon. Friend is absolutely right. This is an international event—a window of opportunity for the United Kingdom—based in the city of Manchester. I am delighted to say that, across the country, Members of Parliament on both sides of the House are fully behind this project.
The national spirit of friendship festival will organise a programme of events in celebration, engaging skills, clubs and communities across the country in the year of Her Majesty's golden jubilee. Sport England is organising youth regional games alongside the Commonwealth games, with events in which up to 250,000 young people can compete. So we are well on schedule for the biggest sporting and cultural event ever held in Britain.

Mr. Graham Brady: The Minister will be aware that there is concern that the high-speed rail link to the games may not be completed in time. Along with Members on both sides of the House, I hope that it will be. What steps have been taken to ensure that the rail link is completed on schedule?

Mr. McCartney: I think that the hon. Gentleman may be mixing up the transport infrastructure for the Commonwealth games with the proposal for the extension throughout Manchester of the metro system. The metro system is not part of the transport infrastructure for the games, and never has been. [Interruption.] I am trying to be helpful to the hon. Gentleman. In terms of getting to the games and getting around the city of Manchester, discussions are taking place with all the transport partnerships, including the buses and trains. There will be a separate, clear transport infrastructure strategy to ensure


that not only is there access to the games from outside Manchester and the north-west but that people in Manchester have fast and easy access to and from all the venues. In addition, we hope to have a ticketing arrangement that includes transport costs. That will make it easier for people to buy a ticket, get on a tram or bus and go to and from the games.

Drug Arrest Referral Schemes

Mr. Michael Clapham: If she will make a statement on the effectiveness of drug arrest referral schemes. [148769]

The Minister for the Cabinet Office (Marjorie Mowlam): There is clear evidence that arrest referral schemes work. For example, in Barnsley, the custody sergeant's promotion of the scheme has helped to accelerate take-up, and drug users not previously in touch with services are being reached. There has been a steady increase in the number of people seen for initial assessment, and a high rate of those attending for drug treatment. Areas where referrals have been working longer show significant reductions in the amount spent on illegal drugs, and drug-related crime has been reduced by as much as 80 per cent.

Mr. Clapham: I am grateful to my right hon. Friend for that answer. I thank her for her recent visit to Barnsley, when she was able to hold discussions with the chief executive of Barnsley metropolitan borough council, the co-ordinator of the community partnership and the vice-chair of DAT—the Drug Action Team—Barnsley's drug strategy. From those talks, she will be aware that the drugs referral system is vital in getting young offenders who are on drugs into treatment. Does my right hon. Friend agree that there is a need to strengthen the community support services after treatment? Will she look into how resources might be focused on improving that service to complement the referral system?

Marjorie Mowlam: I certainly recognise what my hon. Friend says—helping young people stay off drugs and giving them support once they have finished treatment is crucial. The best approach to ensuring that that care is provided is to make certain that the partnership that developed during the arrest referral continues afterwards. I hope that system is working in Barnsley; as my hon. Friend pointed out, I heard about it while I was there.
We are also working to encourage young people to stay away from drugs—not just helping with treatment and post-treatment care. I am pleased to announce that an additional £152 million is going into drug education for young people, particularly to identify the most vulnerable and those most at risk so that they can be given special help.

Mrs. Ann Winterton: How soon does the Minister expect that drug arrest referral schemes will have an effect on reducing drug-related crime nationally? Does she agree that, unless the early release of 3,000 drug dealers is halted forthwith, Government targets will be seriously jeopardised?

Marjorie Mowlam: As I have just said, where the schemes are working, there is already a real decrease in

crime. Arrest referral schemes are being rolled out across the country at present and, by the end of this year-definitely by next year—we hope that most areas will have them. The schemes bring results.

Mrs. Winterton: What about early release?

Marjorie Mowlam: That is a matter for the Home Office. It is important that when people are in prison we give them help to ensure that they come off drugs. Whatever the reason for them being in prison—whether they are dealers or people caught using drugs—the best course is to get them off drugs so that when they get out, they do not continue with the same behaviour.

Dr. Brian Iddon: Is my right hon. Friend aware of the concern that those who enter drug treatment programmes through the judicial system might displace those who do not do so? If that is true, it could send out dangerous signals.

Marjorie Mowlam: Let me assure my hon. Friend that that is not the case. In areas where demand is high or fluctuating, adequate treatment—whether inside or outside the judicial system—is not always available. The national treatment agency that will be set up with £145 million will provide the additional treatment needed. That is being rolled out at present. Local drug teams are putting in their requests, so where there are problems—I readily acknowledge the problems—they will be dealt with.

Rural Development

Mr. Andrew George: What recent discussions she has had with her colleagues in other Departments on the co-ordination of rural development. [148770]

The Minister for the Cabinet Office (Marjorie Mowlam): I chair the ministerial rural affairs group, which provides a forum for discussions with colleagues on rural development and other issues.

Mr. George: I am grateful to the Minister for her reply, but what has happened since the establishment of the Cabinet Committee on rural affairs? How often has it met? Does it recognise that there is an urgent crisis in rural areas? What action is it taking with other Departments to address the fact that small family farms are going out of business in their droves? After all, they are the bedrock of rural life in this country and they deserve better treatment. How is the Cabinet Committee addressing that issue?

Marjorie Mowlam: The ministerial rural affairs group is co-ordinating rural policy and rural proofing to ensure that Departments consider the impact of their policies on rural areas, that the policies work as effectively as possible to support rural life, and that a joined-up approach is taken to tackle the problems faced by rural communities. The hon. Gentleman refers specifically to small farms. We have put £1.6 billion into the English


rural development programme, which will provide vital support to help farmers to play a role in diversifying their production in the economy.

Mr. Tony McWalter: Does my right hon. Friend agree that, although the initiatives on farms from the Ministry of Agriculture, Fisheries and Food and on village post offices from the Department of Trade and Industry have played an important part in assisting rural regeneration, local authorities are the principal agents of joined-up government in rural areas? Will she evaluate whether this year's well above inflation settlements for local authorities have gone a long way to improve the co-ordination of service; in rural areas?

Marjorie Mowlam: The additional funding for local authorities will help co-ordination and delivery in rural and urban areas and is a welcome development, so efforts are already being made in relation to rural areas. We have put an extra £239 million into transport, with an extra £15 million in parish funds for community-based solutions. Alongside the £37 million in extra funding for market town regeneration, that shows that we are making noticeable progress. It should be compared with the Tory party's record in government, when 30,000 post offices were closed, one in four parishes were without a bus service and 30 village schools close d each year. I hope that the hon. Member for New Forest, East (Dr. Lewis) bears that in mind before he asks his question.

Dr. Julian Lewis: Is it not a fact that the only real rural co-ordination going on at the moment is the massive co-ordination for the even more massive march that will be held on 18 March to protest about the way in which the Government keep attacking the rural way of life and neglect totally the problems of the countryside?

Marjorie Mowlam: If the hon. Gentleman's party had not neglected rural areas when in power, the anger would not be so great. We inherited one in four parishes with no transport; 3,000 schools closing; a transport system that was not working; and village schools that were closing. In comparison, we have put money into transport and given a 50 per cent. rate relief to village shops, pubs and garages—which are crucial to communities—and £40 million extra to support small schools, and there is an affordable house scheme. We are concerned about rural areas and we are making a difference. Yes, people are unhappy because we are having to make a lot of progress very quickly, given what we inherited from the Conservative party.

Mr. Jim Dobbin: My constituency has rural areas to the north and west. What is the Government's commitment to rural Britain after years of neglect?

Marjorie Mowlam: I have talked about rate relief for village shops and the money for transport and schools, but, at the same time, we are encouraging housebuilding on brownfield sites, which is terribly important if we are to have a sustainable policy to keep the green belt alive. We have saved a lot of green belt with our emphasis on

building on brownfield sites. We have an area of greenbelt land the size of Bristol. All that we need to do is compare that with what the Opposition did when in government.

Mr. Andrew Lansley: Has the rural affairs committee focused in its discussions on the issue of farm incomes? I am sure that the Minister will agree that many rural areas have been very hard hit by the fall in farm incomes by three quarters, so will the Government claim the agrimonetary compensation that will be available before 30 April—yes or no?

Marjorie Mowlam: It is common practice not to discuss the detail of a Cabinet Committee's discussions, but I assure the hon. Gentleman that we cover the whole waterfront in terms of rural policy. Since 1997, we have provided an extra £1 billion to help the farming industry through difficult times and, now, an additional £1.6 billion for the English rural development programme will provide vital support to help farming play a greater role in the diverse economies in rural areas.
On Europe, I assure the Minister—[Interruption.]—the Leader of the Opposition—[Interruption.] I do not know what the hon. Gentleman is.

Mr. Dennis Skinner: Does it matter?

Marjorie Mowlam: I do not think that it does.
I assure the hon. Gentleman that, in relation to Europe, we are working hard to maximise the benefits for industry, including agriculture, in this country. That cannot be said of the Conservative party.

Mr. Lansley: The Minister must know from her discussions across the waterfront that farmers have been hard hit. The Minister of Agriculture, Fisheries and Food has made it clear that this is the worst agricultural recession for many years, and farm incomes are at their lowest in real terms since the 1930s. If ever there were a moment to use the resources that can be claimed from the European Community, it is now and £200 million is available before 30 April. Farmers know that the Conservatives, should we form a Government before 30 April—[HON. MEMBERS: "No."] Yes, and farmers know that the Conservatives will make that £200 million available. Will the Government do that£yes or no?

Marjorie Mowlam: Farmers know that we have been helpful since 1997 and should compare our record with what happened before. In Europe, we are doing all that we can to help farmers to obtain the benefits that Europe offers. The Conservatives promise that the agrimonetary payments will be claimed but, if I were a farmer, I would consider how many agrimonetary payments they obtained when they were in government. The answer is none.

Drug Use

Mr. David Taylor: What new initiatives and resources are planned in the campaign against drug usage by younger adolescents. [148771]

The Minister of State, Cabinet Office (Mr. Ian McCartney): As the Government announced this morning, we are putting £152 million over three years into


co-ordinating and targeting local services to help young people, including those most vulnerable from drug misuse.
The Government's anti-drugs strategy has set challenging targets to halve the numbers of young people using illegal drugs by 2008. We are ensuring that young people receive the help and advice that they need to resist drug misuse, and we shall increase drug education and prevention spending from £63 million this year to £120 million in 2003–04.
In Leicestershire, the county council education department's drug policy is due to be published in the spring of this year, with training planned to support its implementation.

Mr. Taylor: I thank my right hon. Friend for that reply. May I commend to him the work in Leicestershire schools of the life education centres, whose drug prevention education helps many thousands of children make healthy choices? Will he discuss with my right hon. Friend the Secretary of State for Education and Employment ways of sustaining and developing the LECs, particularly in the use of digital technology, to make their programmes more effective with pupils, teachers and parents?

Mr. McCartney: Yes. I am also prepared to come to Leicestershire to hold discussions with my hon. Friend and his colleagues there about how we can build on the work that is already being done in the county to prevent addiction but, when it does, to provide proper treatment. We shall also help to relieve communities in Leicestershire from the stress that drug dealers cause in some of them.

Mr. John Bercow: Is it—[Interruption.] It is always a pleasure to brighten up the lives of miserable Labour Members who are about to lose their seats.
Is it the right hon. Gentleman's policy that young offenders who abuse drugs should be eligible for drug referral schemes? If so, what assessment has he made of attendance at, and participation in, such schemes? Does he believe that it is necessary to have a mixture of a carrot-and-stick approach to ensure compliance? [Interruption.]

Mr. Speaker: Order. I ask the House to settle down; there are too many private conversations.

Mr. McCartney: The issue is not about saving seats; it is about saving lives. Perhaps I can draw the hon. Gentleman's attention to that. The schemes are working effectively. They encourage young people who have a drug abuse problem to take responsibility for seeking out a partnership with the local authority to receive available treatment and to address the issues that arise from the criminal activity related to their misuse of drugs.
The pilot project has had two results: first, there has been a dramatic decrease in criminal activity—up to £300 a week less has been stolen to feed the drug habit; and secondly, a large proportion of the people in the schemes are successfully participating in the treatment programmes and are about to go on to receive education, training and housing. However, it is a hell of a job to get those young people to work in a sustained way in the

community. It is difficult to get them to give up drugs, sustain the lack of drug activity and to go on to a healthy life style, but we must ensure that we get on with encouraging that. I reassure the hon. Gentleman that that is what we are doing.

Mrs. Alice Mahon: May I invite my right hon. Friend to visit Halifax to meet some of the dedicated workers who are employed in drug referral and prevention strategies? Will he join me in condemning the proposals by Tory-controlled Calderdale council to cut staff in that vital service?

Mr. McCartney: First, I would be more than happy to visit my hon. Friend's constituency. Secondly, a year or so ago I went to her local authority to discuss drug issues on estates. I would be staggered if any local authority decided to reduce funding in such a vital service when the Government have put in place a £1 billion investment programme to prevent drug abuse, provide treatment, encourage community safety and reduce the availability of drugs in communities. There is no reason why her local authority should not be involved in a strategy to ensure that the system in her community works effectively to get young people off drugs and into a more proactive life style.

Regulation

Miss Anne McIntosh: If she will make a statement on her role in achieving better regulation by Government Departments. [148772]

The Parliamentary Secretary, Cabinet Office (Mr. Graham Stringer): My right hon. Friend the Minister chairs the panel for regulatory accountability. Yesterday, the Regulatory Reform Bill completed its Report stage in the other place.

Miss McIntosh: Does the hon. Gentleman share my concern that the Government continue to gold-plate European Union directives, the most recent of which were on HACCP—hazard analysis and critical control points—and on meat hygiene inspection? Members of Unison have been consulted and are up in arms at the prescriptive nature of the conditions that will be imposed on United Kingdom producers but that would not have to be met by our EU competitors.

Mr. Stringer: Most of the complaints that I receive about gold-plating come from the time when the Conservative party was in government. The Cabinet Office, under my noble Friend Lord Falconer, has issued new guidelines on the transposition of European legislation.

Mr. Huw Edwards: Would my hon. Friend consider better regulation of the steel industry by Departments in view of Corus's decision not to allow the workers to buy out Llanwem steel works because it would produce competition? According to Sir Brian Moffatt, it is better to get rid of manufacturing at Llanwern and Ebbw Vale than allow competition. Does he agree that no one should treat, or be allowed to treat, their work force in that way?

Mr. Stringer: I share my hon. Friend's concern about the possible loss of jobs in the steel industry. My right hon. Friend the Secretary of State for Trade and Industry is still in discussions about those jobs.

Health Information

Mr. David Amess: If she will make a statement on her Department's role in co-ordinating the information relating to health in the Government's annual report. [148776]

The Minister for the Cabinet Office (Marjorie Mowlam): rose—

The Minister of State, Cabinet Office (Mr. Ian McCartney): rose—

Marjorie Mowlam: The Government's annual report was produced by the strategic communications unit in the Prime Minister's office. Chapters on each section were written in collaboration with advisers from No. 10 and the relevant Departments. [Interruption.]

Mr. Speaker: Order. We cannot hear the right hon. Lady.

Marjorie Mowlam: Shall I read the answer again?

Mr. Speaker: Yes.

Marjorie Mowlam: The Government's annual report was produced by the strategic communications unit in the Prime Minister's office. Chapters o r each section were written in collaboration with advisers from No. 10 and the relevant Departments.

Mr. Amess: What a shambles of Government.
Rather than co-ordinate the misinformation on the health service, as contained in page 3 of the annual report, will the right hon. Lady consider co-ordinating exactly when the general public will receive appointments with consultants to diagnose their various problems? Will she consider co-ordination to ascertain where this rotten Government intend to find the staff to run the national health service?

Marjorie Mowlam: In terms of staff, the hon. Gentleman well knows that we are already recruiting more nurses and training more doctors. The situation is improving day by day. If he listened to the facts, he would not have to ask the question.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Mr. Ken Purchase: If he will list his official engagements for Wednesday 14 February.

The Prime Minister (Mr. Tony Blair): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Mr. Purchase: Will my right hon. Friend join me in congratulating Age Concern, which today has published its manifesto for older people? Will he note that, on page 6, it makes a splendid case for increasing and improving the state pension, as the best way of avoiding the indignity of means-testing our oldest and poorest people? Will he give a commitment that the Labour Government will always protect the value of the state pension, rather than let it be whittled away in the disgraceful manner that the Tories allowed?

The Prime Minister: Certainly. There is the £200 winter allowance that has been given to pensioners, there are free television licences for pensioners over 75, and there are free eye tests. This year, there are the increases of £5 and £8, which are meant to be increased even further next year. These increases are greater than those that would be linked to earnings. These are substantial sums for British pensioners, and deservedly so. We shall have spent more money on pensions during this Parliament than if the pension had been linked to earnings. Pensioners can know with absolute certainty that the money comes to them under the Labour Government and would be taken from them under the Conservatives.

Mr. William Hague: Today, people have travelled from throughout the country to lobby the House in opposition to the Prime Minister's policy of abolishing community health councils. When I last asked him about the matter, he said that he would consult on the proposals and listen to the representations made. How many representations has he received in favour of his policy?

The Prime Minister: We have made it clear that we are consulting on the community health councils. Our proposals involve replacing the councils not with nothing, but with patients forums in each hospital and each local general practitioner's premises. There is widespread concern about whether CHCs have performed properly the function of looking after patients' interests. However, we continue to listen to the representations made, and we shall announce our final proposals in due course.

Mr. Hague: As the Prime Minister was happy to quote Age Concern a moment ago, has he listened to Help the Aged, which says that the Government's policy
is likely to lead to confusion and lack of clout in addressing the…representation of patients"?
The Prime Minister's policy is opposed by Age Concern, Help the Aged, Mencap, the British Medical Association, the National Association of Citizens Advice Bureaux, the General Medical Council, the Royal College of Obstetricians and Gynaecologists, the National Childbirth Trust and Action for Victims of Medical Accidents. He has not had the decency to admit that nobody is in favour of his proposals. Will he reverse his policy or will he maintain that he knows better than all those organisations?

The Prime Minister: I said that we would listen carefully to people and, indeed, we shall. I do not think


that the right hon. Gentleman will have to wait much longer for the answer. As he is quoting those organisations on our health proposals, he should also quote them in support of the massive extra investment that the Government are making in the national health service—the extra nurses, doctors and hospitals—and on the contrast between the investment going into the health service under this Government and the cuts that there would be under the right hon. Gentleman's.

Mr. Hague: It is no good the Prime Minister wriggling off the point because he does not know the answers to the questions. What about the following representation, with which he should be familiar? It says:
there has been no consultation".
It also says that abolition is a
cynical attempt to silence any negative publicity".
What better way, the organisation asks,
to deflect attention from…shortcomings
of the Government? That was said by South Durham and Wealden community health council, Sedgefield district. Does it not tell us something when the people who know the Prime Minister best say that he does not listen, that his policy is utterly cynical and that he is interested only in publicity? Have they not got it in one?

The Prime Minister: I think that the right hon. Gentleman's comments may look a little foolish when the results of the consultation are announced, if I may respectfully say so. As this is about the only health service subject that he dare raise—he knows that he has nothing to say about anything else—it is correct that there have been many representations on community health councils, and it is for that reason that we said we would listen to them.
If we are to have a balanced debate on the health service, however, let us also debate the amount of investment and change going on. The fact is, we are prepared to put that extra investment in to the NHS, far more than the right hon. Gentleman ever did. Perhaps, in the interests of an exchange of views, the right hon. Gentleman can say whether it is still the case that he will take £750 million out of the NHS for private medical insurance.

Helen Jackson: Does the Prime Minister remember the snarl-ups that we used have in the Chamber on the minimum wage and the bogus arguments threatening a cataclysmic loss of jobs? Is he aware that, at that time, one in every five workers in South Yorkshire were earning less than £3.50 an hour? They are now between £30 and £40 a week better off; and unemployment has halved. Is my right hon. Friend surprised that the Opposition have changed their mind about that policy?

The Prime Minister: I am proud that the Government introduced a statutory minimum wage which has helped hundreds of thousands of low-paid workers in this country out of poverty. Some said that it would increase unemployment. In fact, today we have the lowest unemployment in the country for over 25 years; we have the lowest inflation in Europe; national debt is down;

interest rates—and therefore mortgages—are half what they were in the Conservative years. We can, and do, have both economic efficiency and social justice.

Mr. Charles Kennedy: On 13 December last year, the Deputy Prime Minister advised the House that he anticipated that rail services would be back to normal by Easter, having earlier said that they would be back to normal by January. Given the recent reports that the Office of the Rail Regulator now estimates that rail services will not, in any way, be back in efficient running order before the summer, does the Prime Minister still confirm the earlier statement of the Deputy Prime Minister?

The Prime Minister: It is our understanding that rail services will be back to normal by Easter, but of course that depends on Railtrack and the companies carrying out the work that they have agreed, which is precisely why we will carry on putting pressure on them to do so. There is no doubt that for many passengers still, particularly on the inter-city lines, the situation is simply unacceptable. The only way that we will cure the problem long term is to make sure that we have proper strategic control of our rail industry, given tip under privatisation by the Conservatives, and that we put the urgently needed investment into our railways.

Mr. Kennedy: We want safe, reliable, affordable rail services. In that case, should not the Government's strategic approach be, first, to reduce the ridiculous number of train operators, and secondly, to turn Railtrack into a non-profit-making organisation? If the Government did that, they would demonstrate that they put passenger safety before Railtrack's commercial profits.

The Prime Minister: There is, as we know, a strong case for better securing passenger safety. I do not know what the right hon. Gentleman means by a not-for-profit organisation, but it is vital that we get strategic control, which is what the Strategic Rail Authority will do. Secondly, and perhaps above all, we need to make good the investment in our railways.
The country has a simple choice: either we invest in the basic public services and the infrastructure, or we go back to the cuts and privatisation that we had for 18 years before. We have set out clear plans for investment, which I hope the right hon. Gentleman supports. I know that in time—and it will tale time—they will deliver a better rail infrastructure. There is no point in believing that we can get decent public services unless we are prepared to pay for them.

Mr. Gerald Kaufman: Can my right hon. Friend be persuaded that winter fuel payments for pensioners and free TV licences for those aged 75 and over are complicated when pensioners want simplicity, and patronising when pensioners want respect, and that they should be abolished—in which case he agrees with what the leader of the Conservative party was saying at the beginning of last week? Or does my right hon. Friend believe that many pensioners are happy to receive winter fuel payments and free TV licences, and that they should


be maintained—in which he agrees with what the leader of the Conservative party was saying at the end of the week?

The Prime Minister: My right hon. Friend, as ever, makes his point extremely well. The complications involved in trying to organise the system along the lines suggested by the Conservative party would be appalling in terms of bureaucracy, red tape acid so on. The basic point is that the £200 winter allowance is popular and it is right. The free TV licences for those over 75 are popular and right. The rise in the basic state pension coming in this April is, again, the right thing to do. We will carry on standing up for the proper interests of British pensioners.

Mr. James Gray: This time last week, the Prime Minister promised that if he were re-elected, he would hold a referendum on the question of scrapping the pound. That comment was well noted in Wiltshire, where people do riot like it at all. Does the Prime Minister remember promising his friends in the Liberal Democrat party that he would hold a referendum on proportional representation? Will that be within two years?

The Prime Minister: The hon. Gentleman will have to wait for the manifesto for all that. On the euro and the good people of Wiltshire, whom I think the hon. Gentleman represents, I believe that what they will like most is the fact that interest rates came down last week. They will like the fact that job numbers are up, living standards are up, and from this March and April, there will be a family tax cut for millions of families which would be taken away by the Conservative party.

Mr. Joe Ashton: Is my right hon. Friend aware of the great satisfaction that there is in the north Nottinghamshire and South Yorkshire coalfield areas at the announcement of the £60 million subsidy for six pits, which is gratefully received? Is he t ware that, for years, I and many of my colleagues marched under banners calling for "coal not dole", as the Conservatives butchered 270,000 jobs in the industry, in which there are now 20,000 jobs left? The Conservatives got their answer when they were butchered at the last election. Will my right hon. Friend accept the thanks of us all?

The Prime Minister: There is now huge investment—hundreds of millions of pounds—going into coalfield communities, not only to preserve those jobs in Britain's mining industry, but to provide hope for areas that have lost their mining industry. I think that that is right and necessary, because it gives us the chance to regenerate these areas. It is one reason why unemployment is so low in this country today.

Mr. Julian Brazier: Is the Prime Minister aware that during the past fortnight in east Kent, more than 100 people have been waiting on trolleys in our three casualty departments? They include a woman of 97 who had to wait for two nights. Is he aware that 80 consultants from the three Kent sites last night voted unanimously for a motion saying that lack of capacity is compromising their ability to deliver health care? Is he

still committed to an ill-conceived £100 million reorganisation that will not add a single bed and which was opposed by the local community health council?

The Prime Minister: Of course it is entirely unacceptable if people are waiting that long on trolleys. The hon. Gentleman and his consultants rightly say that the issue is one of increasing capacity. That is precisely why we have increased capacity and are increasing it year on year. Let me remind him and Opposition Members that they cut 40,000 to 60,000 beds in the national health service. When we came to office, they had cut the number of nursing places and the number of training places for midwives, and they were cutting capital investment in the health service. In all those areas, we are putting the investment in. It will take time, but the one group that has no cause to criticise is the Conservative party.

Wimbledon

Mr. Roger Casale: What plans he has to visit Wimbledon.

The Prime Minister: I have no immediate plans to do so.

Mr. Casale: When my right hon. Friend does come to Wimbledon, he will discover that low interest rates are one of the achievements that my constituents most identify with a Labour Government. Home owners are now paying less than £700 a month for an average mortgage, compared with more than £760 a month in 1992 under the Tories. Will he assure the House and my constituents that he will continue with his Government's policies to set a course for economic stability? Nobody in Wimbledon wants to go back to the high and fluctuating interest rates, negative equity and house repossessions that were the legacy of Tory boom and bust. [Interruption.]

The Prime Minister: Conservative Members seem to think that my hon. Friend's constituents will not be interested in economic stability or low interest rates. I think they will find that they are rather wrong. Of course, the importance of low mortgage rates is that there is nothing better for hard-working families who are pressed to make ends meet than being able to rely on low rates and thus on lower mortgage payments. On average, they are running about £1,000 a year less under this Government than they were when the Conservative party was in government. People remember the days of interest rates at 15 per cent., negative equity, repossession and boom and bust, and they never want to go back to them.

Engagements

Mr. Ben Chapman: May I welcome the employment figures published today? They show that unemployment in Wirral, South, for example, has fallen by a third generally since the last election, and by 80 per cent. among long-term unemployed young people. My right hon. Friend will appreciate, however, that structural change is occurring, not least in manufacturing, and that the picture will vary from area to area. Excellent though the figures are, does he agree that the Government will be judged not only by these excellent headline items, but by the way in which they handle the


process and help the areas, individuals and communities that are affected by economic and industrial change? [Interruption.]

The Prime Minister: A moment ago, the Opposition were not interested in listening to what was said about interest rates; now they are not interested in jobs either. Today's figures show that unemployment is now at a record low for almost 25 years. Many people remember when 3 million were unemployed. The figures indicate, along with the fact that there are still 1 million vacancies in the economy, that we are finally providing the ability not only to have economic stability, but to put on top of that a productive job-creating base for the economy. That is immensely important.
I hope that the whole House recognises that when there are more jobs in the economy, more wealth is created for this country and we can make the investments in our public services that people so desperately need. There is a pretty obvious answer to why the right hon. Member for Richmond, Yorks (Mr. Hague) never asks me any questions about the economy.

Mr. William Hague: Let me ask the right hon. Gentleman for some figures. The Minister of State, Home Office, the hon. Member for Hornsey and Wood Green (Mrs. Roche), stated in a written answer on 23 January that the cost of asylum support was £664 million. Does the Prime Minister stand by her answer?

The Prime Minister: Yes.

Mr. Hague: Even by the Government's standards, their reputation for honest answers has sunk to a new low. The real cost to the taxpayer was sent from the Home Office to No. 10 Downing street in the same week as the parliamentary answer was given. Total asylum support costs £835 million. The covering memo from the Home Office states:
this report is for internal information…lines to take for public use will be provided separately".
Will the Prime Minister stop using the
lines to take for public use",
give the real internal information, and provide a straight answer to the people of this country?

The Prime Minister: That is quite wrong. The budget is as I set it out a moment ago, and accords with the figure that the right hon. Gentleman first put to me. He describes the costs that depend on, and fluctuate because of, the number of asylum seekers. They will go up and down. However, as a result of our measures, approximately three times as many asylum seekers are being removed now as five years ago. From next year, somewhere in the region of 30,000 will be removed. That will reduce those costs considerably.

Mr. Hague: Once again, the Government have been caught out on their statistics. We know that the budget was £660 million. The right hon. Gentleman and the Minister were asked about the cost. The Prime Minister talks about the number of removals; will he confirm that, of the 69,000 asylum claims that were rejected last year, only 9,000 claimants left the country? Taken together,

do not the figures demonstrate the collapse of the Government's asylum policy? They have made this country a soft touch and turned us into the asylum capital of Europe. Everyone knows the Government's true record: a record number of applications, a record number of people avoiding deportation, and a record amount of deception and failure.

The Prime Minister: Perhaps I can give the right hon. Gentleman the facts The figure of 9,000 is correct. As I said earlier, that is three times the number of people who were removed five years ago under the Conservative Government. However, the overall number of people removed is some 46 000.
Which policies will reduce the number of those entering the country an end to cash benefits, penalties on lorry firms that bring in illegal immigrants, or a boost to the number of people who work in the immigration and nationality department? We have introduced all those measures; the right hon. Gentleman has opposed every one. Let me explain, so that the public understand, that he goes around the country telling people that asylum is a terrible problem while obstructing in the House of Commons every move that allows us to deal with it.
The right hon. Gentleman is wrong to say that Britain has the highest number of asylum seekers per capita. In the past six months, Britain's numbers have remained constant, while Sweden has experienced a 53 per cent. increase, Denmark a 44 per cent. rise, France a 13 per cent. increase, and Belgium a rise of 16 per cent.
We say that our measures are best for dealing with asylum seekers; the right hon. Gentleman says that he would set up detention centres for all asylum seekers, genuine or not. Conservative Members nod their heads. We have proposed one detention centre at Aldington; they have opposed its establishment. They oppose one detention centre while saying that they will create 50. That says all that needs to be said about the right hon. Gentleman's policy.

Hon. Members: More!

Mr. Speaker: Order. I call Mr. Jim Cousins.

Mr. Jim Cousins: On Monday, the Prime Minister rightly set out the need to improve educational opportunity. Nowhere is that need greater than in the north-east of England, as he well knows. Will he promise the people of the north-east of England an early opportunity to decide for themselves whether they, like the Scots, want a political voice to tackle their deep-seated problems for themselves, rather than just being the victims of them?

The Prime Minister: As I have said before, that is a matter for local people to decide. I understand the case for a regional assembly. The advent of the regional development agencies has been immensely important in the north-east and other areas. In our region, they have safeguarded some 11,000 jobs and brought in a great deal of inward investment. That is why I believe that it is so


important that we keep the regional development agencies and build them up, rather than abolishing them as the Conservative party has suggested.

Sir Richard Body: Will the Prime Minister help the lobby outside by telling us how many representative bodies have called on him to bring to an end community health councils?

The Prime Minister: As I said in answer to the right hon. Member for Richmond, Yorks (Mr. Hague) earlier, we will have to wait for the outcome of the consultation that will be announced soon. I hope that the hon. Gentleman will agree that the size the investment in the national health service is a better testimony to our commitment to the national health service than the cuts proposed by the Leader of the Opposition and his colleagues.

Mr. Michael Connarty: Is my right hon. Friend aware of the warmth with which Polish people and people of Polish descent in this country welcome the setting up by the Government of a commission to examine the substantial contribution of Polish people—some of whom did not survive—in fighting alongside the allies in the second world war? Is he also aware of their hope that the Government will not be diverted from the path to enlargement of the European Union by the xenophobia shown by the Opposition?

The Prime Minister: We have been advocates for the enlargement process right from the beginning. The vision of a unified Europe, east and west, is a vision of peace and prosperity for all the people in Europe for the future. That is why this country will continue to advocate enlargement, and why we will not allow any obstruction to get in the way of that enlargement process moving forward.

Mr. Nicholas Winterton: Does the Prime Minister believe that physiotherapy provided to an elderly person who has suffered a stroke should be provided free in their own home or in a residential or charitable nursing home? Does he also believe that elderly people who are not in hospital but in their own home or in a residential home and require incontinence pads should be entitled to receive them free under the national health service? If he does, will he ensure that the Secretary of State for Health issues a proper definition of personal social care as soon as possible?

The Prime Minister: It is important that the definition is right. Nursing care, in future, will be free. We had to take a decision— [interruption.] Opposition Members may grumble, but none of those provisions were free under the previous Government. Let me just point that out to them: we are introducing free nursing care. We have

chosen not to introduce free personal care because it would cost about £1 billion, and we believe that that money would be better spent elsewhere.
I must also point out to the hon. Gentleman that, in addition to the investment in free nursing care, we are also investing a large sum of money in trying to provide for people to be looked after in their own homes. The number of at-home care packages has been increased by many tens of thousands. Those, of course, are funded by the state. I agree that it is important to have a precise definition, and we shall have one, but I believe that the balance that we have struck between nursing care and free personal care is the right one.

Mrs. Louise Ellman: Will my right hon. Friend the Prime Minister give his personal attention to resolving issues concerning state aid that are currently holding back a number of important public-private sector investments in the Merseyside objective 1 area? Does he agree that speedy resolution of that issue is essential to enable the Government's policy of supporting private investment as part of regeneration to be maximised throughout the country?

The Prime Minister: I entirely agree about the importance of proceeding as quickly as possible with the public-private partnerships that will yield such benefit in terms of investment and jobs in regions such as the north-west, particularly those undergoing structural economic change. I can offer my hon. Friend this assurance: we will do all we can to make progress quickly.

Mr. Crispin Blunt: In July, in the House, the Prime Minister promised Labour Members a free vote on the report "Shifting the Balance". On Monday—not that the Prime Minister troubled himself to vote—they were denied a free vote.
If the Prime Minister does not allow Labour Members a free vote on "Shifting the Balance" before the general election, what possible construction can the country put on the Government's behaviour—except the construction put on the Government's response to the Liaison Committee's first report by Peter Riddell of The Times, who said that the behaviour of the right hon. Gentleman's Government was arrogant, contemptible and mendacious?

The Prime Minister: I understand that the debate took place on a Tory Opposition day, so it is hardly surprising that we should oppose what the Opposition wanted. Let me offer the hon. Gentleman some advice, however. Next time he asks a question at Prime Minister's Question Time—perhaps a question on the economy—he should recall the words of Lord Strathclyde, which I think bear repeating. Just a couple of days ago, Lord Strathclyde said:
I think there's always a danger of political parties peaking too soon, and I think William Hague and the shadow cabinet have very cleverly avoided that.

Speaker's Statement

Mr. Speaker: I have a short statement to make about the conduct of Question Time. I wish to ensure that the four hours each week that the House devotes to Question Time are used to best effect.
The primary purpose of Question Time is to hold the Executive to account. "Erskine May" says that a question must either seek information or press for action, and that it must relate to matters for which Ministers are officially responsible. Questions are out of order if they relate to Opposition party policies rather than Government responsibilities. Moreover, a question should not be, in effect, a short speech. [Interruption.] Order. There is more.
Answers should be confined to points contained in the question—[Interruption.] Order. I must deal with criticisms from both sides of the House. As I was saying, answers should be confined to points contained in questions, giving only such explanation as renders an answer intelligible. A certain latitude is permitted to Ministers, but it does not extend to Ministers discussing Opposition policies at length, or to their putting a series of questions to Opposition spokesmen. It is those long-established rules that maintain the difference between Question Time and ordinary debates in the House.
Of course I recognise that, over many years, Question Time has developed as a lively occasion on which political points are scored. That applies particularly to Prime Minister's Question Time. As I said last week, although the same constraints apply, I think it right to allow the Prime Minister and the Leader of the Opposition a greater degree of latitude.
I emphasise that I do not wish to interrupt the flow of questions and answers, but I believe that the House would work better, and would enhance its reputation, if Members followed the basic principles that apply to Question Time. In particular, it is crucial for questions and answers to be short and to the point; that will allow more Members to make a contribution.
Members on both sides of the House have got into bad habits at Question Time, and we must all co-operate to put matters right. I look to Ministers, and to other Members, to respect the rules and practice of the House. I also expect Members to allow me to preside over the House without sedentary comments or noises designed to influence the conduct of the Chair.

Points of Order

Mr. Nigel Griffiths: On a point of order, Mr. Speaker. Some hon. Members have been very concerned that the Opposition's policies have been mentioned at Question Time. We are therefore grateful to you for saying today that they should not be dealt with at Question Time. It is after all, merely cruelty to examine those policies, which are so transparently poor that, on that basis, the country will never elect the Opposition to government.

Mr. Speaker: Order. That is not a point of order for me.

Mr. Nicholas Winterton: On a point of order, Mr. Speaker. This is a very basic point of order which affects the welfare of many hon. Members. May I advise you that every lavatory in Portcullis House is out of order? As that problem is in addition to problems with the escalators and with the lifts, could you please investigate the matter? I believe that, after forking out £250 million of taxpayers' money for that place, we deserve better value for money.

Mr. Speaker: Order. There was a burst water main in Bridge street.

Mr. Denis MacShane: On a point of order, Mr. Speaker. We shall study your ruling with great care. I was not quite clear which were your own words as Speaker, which we must follow, and which were words quoted directly from "Erskine May". I think that my constituents sent me to this place not only to test and question the Executive, but, in part, to test and question the ability of the alternative Executive, who are sitting on the other side of the, Chamber. [HON. MEMBERS: "No."] That is a serious part of my job as a Member of Parliament. I should be grateful if, in due course, you could give some reflection to that duty that I have as an hon. Member, Mr. Speaker. [Interruption.]

Mr. Speaker: Order. I think that the best thing the hon. Gentleman could do, if lie has not already done so, is to read "Erskine May". It would make good reading for him.

Mr. John Hayes: On a point of order, Mr. Speaker. You will be familiar with the paragraph 1(iii) of the ministerial code, which states: 
It is of paramount importance that Ministers give accurate and truthful information to Parliament, correcting any inadvertent error at the earliest opportunity.
This time last week, the Prime Minister told the House that there were 500,000 extra students in further and higher education since the Government came to office. However, that figure is contradicted by all the information that is available in the Government's own statistics, and it is certainly wildly inaccurate. Has the Prime Minister come to you, Mr. Speaker, or made any other attempt to correct that inaccurate information? If he has not done so, how can I press hire to ensure that his own ministerial code is brought into force?

Mr. Speaker: No approach from the Prime Minister has been made to me. However, the hon. Gentleman is able to use the Order Paper, and I suggest that he does so.

Mr. Tam Dalyell: On a point of order, Mr. Speaker. May I enthusiastically welcome your statement, as far as it goes? However, if your wishes are not carried out, could you reflect on whether it is sensible to have open questions to a Prime Minister? Considering the amount of prime ministerial time that is taken up in preparing for questions that may be asked on any subject, is there not an argument for having specific questions to the Prime Minister?
To cater for the needs of the Leader of the Opposition, is there not an argument for reflecting also on whether, if the Leader of the Opposition wants to pursue a subject at length. which he is entitled to do, greater use should be made of the private notice question? A long time ago, when I was first elected to the House, Hugh Gaitskell would use the private notice question if he wished to pursue a particular point with Harold Macmillan, which made possible a sequence of questioning that really did hold the Executive to account. One could ask whether it is possible for those ridiculous open questions to be effective in holding any Executive to account.

Mr. David Winnick: Further to that point of order, Mr. Speaker.

Mr. Speaker: Order. May I first answer the point raised by the hon. Member for Linlithgow (Mr. Dalyell)? It is open to the hon. Gentleman to make approaches to the Procedure Committee and the Modernisation Committee. Perhaps I could suggest that he does that.

Mr. Winnick: Further to that point of order, Mr. Speaker. Will you bear it in mind that if we were restricted to the sort of questions that my hon. Friend the Member for Linlithgow (Mr. Dalyell) has suggested, it would make Question Time far lest, topical? If an issue arose that an hon. Member on either side wished to raise—particularly at Prime Minister's Question Time—it would be virtually impossible to raise it, as you would rule it out of order. Open questions came about to give Members of this House, both Opposition and Government, much more flexibility. I hope that there will not be a decision to change that; it would be a retrograde step and against the interests of Back Benchers.

Mr. Speaker: Once again, I would say that these are matters for the Modernisation Committee and the Procedure Committee. The hon. Gentleman has a view contrary to that of his hon. Friend. He could make that view known.

Mr. Patrick McLoughlin: On a point of order, Mr. Speaker. On 18 April 2000, the previous Speaker announced to the House that she had had long discussions with the head of the civil service and the Cabinet Secretary about letters from Ministers taking a long time to get to Members. I wrote to the Department of Health on 29 September for some information that it would have been fairly easy to provide quickly. The Department acknowledged, in the first paragraph of the reply, the name of my constituent, and went on to say:
You and your constituent will be please d to learn that the British Medical Association currently runs a mentoring scheme for overseas doctors. They can be contacted at

British Medical Association
BMA House

Tavistock Square

London".
The phone number was then given. The letter continued:
I hope this information is of use to you and your constituent.
I sent the letter to the Department of Health on 29 September; I got that reply on 12 February. It was not a difficult issue, and I would have thought that the reply could have come a lot more quickly. Do you think that Members of Parliament are getting the right service at the moment?

Mr. Peter Luff: Further to that point of order, Mr. Speaker.

Mr. Speaker: Order. If I answer the first point, perhaps the hon. Gentleman will not have to raise a point of order. I cannot comment on the particular case that the hon. Member for West Derbyshire (Mr. McLoughlin) raises, but I would expect Ministers to act promptly on correspondence from all Back Benchers on both sides of the House. I am a Member of Parliament myself and I expect prompt and full replies. I hope that that is taken on board.

Mr. Luff: Further to that point of order, Mr. Speaker. I have had similar problems with the Department of Health on many occasions; without doubt, it is the worst Department in Whitehall for responding to letters in good time. A reply to my parliamentary question last year said that the Department's target for replying to hon. Members' letters was 20 working days. I cannot immediately recall a letter to which I have had a reply within 20 working days. I have been pursuing the case of my constituent Kevin O'Donnell for two and a half years, and the average length of time for a reply to a letter is six to nine months. Can I urge you to see whether there is something you can do to encourage the Department of Health, in particular, to reply to letters more punctually?

Mr. Speaker: I replied to the hon. Member for West Derbyshire on that point, and I hope that my comment is taken on board.

Mr. Stuart Bell: On a point of order, Mr. Speaker. May I add to the points made by my hon. Friends the Members for Linlithgow (Mr. Dalyell) and for Walsall, North (Mr. Winnick)? It was the practice of the House to have closed questions to the Prime Minister in the age of Mr. Macmillan. He stood up and simply referred the question to the appropriate Minister, and Prime Minister's Question Time more or less collapsed. That is the reason why the open question came in.
Can I refer you to another point that has struck me over many years? It may be useful for you to draw attention to it, Mr. Speaker. The only second person singular in the House is yourself, and far too many right hon. and hon. Members from both sides use the word "you" across the Floor of the House, when they should be referring to "right hon. and hon. Members". It might be appropriate to add that to your earlier statement, so that all right hon. and hon. Members know what they should do.

Mr. Speaker: I have noticed that practice. Most hon. Members, with the exception of those who have come in


following by-elections, have been Members for four years now. They should know the conventions and rules of the House.

Mr. Dennis Skinner: Oh for the golden days—but they never happened. You will find if you scan the Hansard record of Parliament in 1964, Mr. Speaker, that on occasions so few people wanted to participate in Prime Minister's questions that my late hon. Friend Eric Heffer asked two in questions in 15 minutes.
I am trying to convey the fact that it is a different world now, with different attractions. Parliament is on television, and on C-SPAN in America—and one of the reasons for that is the to and fro of Prime Minister's Question Time. It would be a sad day if we were not allowed to put our points across. I am also extremely pleased that you said that we should not talk about Opposition policies at length.

Several hon. Members: rose—

Mr. Speaker: Order. Let me answer the hon. Gentleman. I must say that I do miss the times when I used to sit with him below the Gangway and he told me those stories.

Mr. Dalyell: Further to that point of order, Mr. Speaker. My hon. Friend the Member for Bolsover (Mr. Skinner) mentioned a golden age, but I am unashamedly of the Jurassic age. The wider and more sensitive issue is the extent to which Prime Ministers, whoever they are, think that Question Time allows them to interfere in every

Department of Cabinet government. Like other hon. Members, I gave evidence to the Procedure Committee on this matter, which is part of the deeper question about the role of a Prime Minister and a Cabinet in a parliamentary democracy. That question should be addressed.

Fiona Mactaggart: rose—

Mr. Speaker: Order. This will be the last point of order.

Fiona Mactaggart: Further to those points of order, Mr. Speaker. Your statement did not mention the behaviour of the hon. Members who are listening to the questions and answers. I have been concerned about the lack of listening in the Chamber, and I know that it distresses my constituents. Could you use your office to encourage hon. Members to listen more carefully to each other, so that we call hold people to account instead of merely listening to people shout at each other?

Mr. Speaker: I agree with the hon. Lady and I hope that hon. Members will listen to me. That would help.

BD PRESENTED

ADOPTION OF SEWERS

Mr. Andy King, supported by Mr. Stephen Hepburn, Mr. Martin Bell? Mr. Steve McCabe, Mr. Bill Olner, Mr. Peter Bradley, Mr. David Stewart, Mr. Tony Clarke and Mr. Tom Brake, presented a Bill to require sewerage undertakers to adopt all remaining unadopted sewers; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 9 March, and to be printed [Bill 47].

Consumer Accountability and New Mutuals

Mr. Gareth R. Thomas: I beg to move,
That leave be given to bring in a Bill to emend the Industrial and Provident Societies Act 1965 to allow for the creation of community mutuals; and to improve accountability of key services to consumers.
Community mutuals offer a marriage between low-risk community ownership of key services and a competitive, efficient operation and culture. They offer an approach that pulls together the best aspects of both public and private ownership. In short, the new mutuals could be powerful efficient enterprises, accountable to the communities and consumers who only on their services. They offer, for example, a different option for the future of the water utilities and for Railtrack, currently in the private sector. Equally, they offer new options for services now in the public sector, such as care services, housing and so on.
The privatised water companies have been successful in many ways, but they have not succeeded in winning the trust of the many consumers genuinely concerned that shareholders' interests be placed ahead of their own. There is on-going concern about the commitment of water companies to the investment necessary to enhance water quality and modernise the water deli very infrastructure.
There has also been considerable concern at the performance of Railtrack since the privatisation of the rail network, and especially since the Hatfield crash. Railtrack has refused to say whether the cost of the repair work since Hatfield meant that it would cut its annual dividend for the year to April. Indeed, its dividend payment to shareholders was in fact increased t y 5 per cent. for the first half of the year. That insistence on financing dividends, when moneys could he used to increase investment levels and help improve services to rail consumers instead, has inevitably increased concern about the sense of priorities among the members of the Railtrack board.
At the same time, equity investors, notably in the water industry, have seen the end of substantial growth in returns because of the entirely welcome and overdue intervention by the regulator. The need to increase returns has driven the search for non-core to business, which many companies have entered into, in an attempt to increase their profits and shareholder returns That additional risk has often been reflected in the cost of capital available to the utilities, reducing their future profitability.
In addition, many utilities feel increasingly pressured and constrained. The pressures of me regulatory system mean that their core monopoly earnings will be highly controlled. Moreover, there is little new equity coming into the water utility sector, with new capital programmes in general having to be financed by debt.
Community mutuals offer a vehicle to deliver significant private capital into key services while increasing the accountability of those services to their consumers in a cost-effective and efficient way. How will they work? Several water companies are already at different public stages of considering how they could vest the core monopoly assets of their business—those

controlled by the regulator, having identifiable income streams and providing essential services to local communities—into the ownership of those same communities via a mutual. Glas Cymru, which was recently allowed by the regulator to take over Hyder's core water business, will be 100 per cent. debt funded, rather than equity funded, because all risky speculative ventures have been stripped from the core business. The lower risk profile will provide high levels of capital efficiency and long-term security, both of which will feed back and benefit customers of the core services.
According to the Financial Times, Glas Cymru is reducing the cost of its capital by almost 25 per cent. by moving to debt finance. The money saved will be reinvested elsewhere within the business to improve the core service further. In addition, the day-to-day operation of that core business can be contracted out in a competitive market to outsource suppliers, who are incentivised to deliver operational and service efficiencies, the benefits of which can also be passed back to the consumer.
A community mutual would own the service. All customers of that service would be entitled to one nominal share in the business and to a vote in electing a board of non-executive directors. In turn, their role would be to provide a strategic direction for the business, to maximise the benefit to the community. Professional executives, who would be responsible for the day-to-day running of the business, would be subject to the control of the elected board, and would be committed to providing only the core monopoly service, while outsourcing any operation that could be provided competitively.
The responsibility of the management of the mutual to achieve success in running the business is no less hard-edged than in any other corporate model. The management would be incentivised by rewards based on achieving targets. Management and the board would be accountable to their consumers for their performance, with those consumers ultimately having the ability to determine who should run the organisation.
As well as offering the powerful attraction of the community owning, and indeed running, the key services on which they rely more efficiently and effectively than at present, community mutuals have other benefits. The ability to become a member, to receive information, to attend and speak at meetings, to vote and to participate in democratic structures, all provide opportunities for individuals in a community to participate and have a role as citizens within that community. As membership is open to any person who is in receipt of the services, there is no financial barrier excluding those who could not afford membership, so those running a community mutual are truly accountable to the entire community that they serve. Hard decisions will inevitably still need to be made by the mutual, but they will be based on the interests of those whose lives will be immediately affected.
Investor-owned services listed on the stock exchange have, on occasion, been criticised for short-term thinking. The focus on the best interests of the company—effectively share price and profitability—and on executive reward schemes based on share options, encourages decision making that brings tangible, quick results. Investment for the long term is clearly necessary and takes place, but commercial expediency determines spending priorities.
The boards and executives of new mutual organisations are free from that disadvantage. They can and must make decisions based on what is in the best interests of the business in serving its community. Clearly, that includes the long-term interests of current members of the community as well as those of future generations.
The most obvious long-term needs that ought to inform day-to-day commercial decisions are environmental issues. Unless there is a specific statutory requirement or an unarguable commercial reason compelling a company to choose a less environmentally damaging but more expensive option, commercial companies' legal duty, whatever they might want to do, is to put the needs of the shareholders first. That will inevitably drive directors to choose the cheaper option, even if it is more environmentally damaging. In a new mutual, carrying on business for the benefit of the community, the directors would be at liberty, and may be legally obliged, to choose the less harmful, albeit the more expensive option.
The opportunities for my constituents as consumers to have a direct influence on the policy and direction of organisations delivering key services such as water, rail, care of the elderly and leisure are negligible and, in truth, would remain limited if the services were, or continued to be, administered by the public sector.
The Government's efforts to modernise local councils, the Strategic Rail Authority and the new water regulator are making important differences in improving the responsiveness of these services to public concern. Community mutuals offer another option—another weapon in the armoury, which is not appropriate in every circumstance—to increase the accountability of key services to their consumers.
I commend the Bill to the House.
Question put and agreed to.
Bill ordered to be brought in by Mr. Gareth R. Thomas, Mr. Andrew Love, Dr. Doug Naysmith, Mr. Paul Clark, Mr. Phil Hope, Mr. David Taylor, Mr. David Drew, Mr. Mike Gapes, Angela Smith, Mr. Adrian Bailey and Mr. Alun Michael.

CONSUMER ACCOUNTABILITY AND NEW MUTUALS

Mr. Gareth R. Thomas accordingly presented a Bill to amend the Industrial and Provident Societies Act 1965 to allow for the creation of community mutuals; and to improve accountability of key services to consumers: And the same was read the First time; and ordered to be read a Second time on Friday 20 July, and to be printed [Bill 48].

Health and Social Care Bill (Programme)(No.2)

The Minister of State, Department of Health (Mr. John Denham): I beg to move,
That the following provisions shall apply to the Health and Social Care Bill for the purpose of supplementing the Order of 10th January:

Consideration and Third Reading

1. Proceedings on Consideration and Third Reading shall be completed at today's sitting.

2. Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion at Nine o'clock.

3. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at Ten o'clock.

4. Sessional Order B (Programming Committees) made by the House on 7th November 2000 shall not apply to proceedings on Consideration and Third Reading.

Consideration of Lords Amendments and further messages from the Lords

5. Paragraphs (6) and (7) of Sessional Order A (varying and supplementing programme motions) made by the House on 7th November 2000 shall not apply to proceedings on any programme motion to supplement this order or to vary it in relation to—

(a) proceedings on Consideration of Lords Amendments; or
(b) proceedings on any further messages from the Lords, and the question on any such motion shall be put forthwith.

The motion proposes that the remaining stages of the Bill should be completed this afternoon. I pay tribute to members of the Standing Committee for what were uniformly constructive and often enjoyable debates. The Bill came under close scrutiny and the Committee stage was, as it should be, a valuable exercise.
There were 14 Committee sittings in total. In only two of the seven afternoon sittings did we fully utilise the time available. Indeed, something like five hours and 38 minutes of scheduled time for the Committee was not utilised. None the loss, I think that we gave the Bill good scrutiny.
There was agreement in the Programming Sub-Committee, and the Government showed flexibility in extending time to discuss additional amendments on primary care although, in the event, the extra time that was allocated was not fully necessary.

Mr. Michael Fabricant: The Minister has shown his customary courtesy in praising the members of the Committee. Will he go further and praise the Select Committee on Health, which opposes the community health council abolition proposed in the Bill?

Mr. Denham: I am not aware that the Health Select Committee has formed an opinion on a specific proposal in the Bill. However, the proposals for a better and more powerful system of patient representation and health service scrutiny we re discussed in some detail in Committee.
It is worth noting that the Committee did not utilise all the time that was available and scheduled for discussion of the issue of scrutiny of the NHS, even though it was arguably the most publicly contentious part of the Bill.


However, we gave it a good degree of scrutiny and, depending on the interest in the House, I imagine that that subject will attract a great deal of attention later when Opposition amendments are debated along with those of my hon. Friend the Member for Wakefield (Mr. Hinchliffe). I look forward to that.
In Committee, the Government tabled a number of amendments. Some were technical and some reflected direct responses to comments that had been made by Members of the House as well as professional and lobby groups. Today's debate and the amendments tabled by Members on both sides of the House will allow us to revisit—albeit in a new form—the major issues on which the Committee spent the most time.
The Government's amendments are for the most part technical and consequential; other amendments pick up on and, I hope, accurately reflect concerns expressed by hon. Members in Committee. We are not introducing by way of Government amendment any major new issues of principle so, in my judgment, one day should give us ample time to debate the remaining stages of the Bill.

Mr. Douglas Hogg: It may well be that the Government are not introducing issues of principle, but the Opposition most certainly are doing so. For example, amendment No. 6, which deals with the abolition of CHCs, is a matter of major importance. That will inevitably mean that many Members will want to speak. The effect of the timetable motion will make that extremely difficult.

Mr. Denham: In Committee, when those matters were discussed in some detail, we did hot take all the time allocated for their scrutiny. I see no reason why we should not hold a perfectly adequate debate later today, which will enable us to examine the issues that hon. Members want to raise.

Mr. Philip Hammond: As the Minister has twice asserted that the Committee did not use all the available allocated time, will he make it clear to the House—for the avoidance of doubt—that the timetable contained fixed milestones, Because of those fixed milestones, it was not necessarily open to the Committee to debate issues that needed further consideration. The total amount of unused time is not an indication that all matters were fully debated.

Mr. Denham: No, but in this case there could have been more discussion of the particular topic that has been mentioned today. The Government flowed flexibility by agreeing to additional time—not all of which proved necessary—to deal with the amendments that we tabled on primary care.
With those comments and in the hope that we can move on to Report at the earliest opportunity, I commend the motion to the House.

Dr. Liam Fox: I oppose the motion on grounds of both principle and practicality. Throughout the appalling number of recent debates on such programme motions, we have made no secret of our belief that a contempt for parliamentary process is being systematically operated by a Government who want to

avoid scrutiny wherever possible. In recent years, there has been an unhealthy strengthening of the Executive—this is the latest and greatest manifestation of that trend. It diminishes the authority of Parliament itself; it diminishes the voice of each us to represent the needs, wishes and interests of our constituents on a range of issues.
Increasingly, with automatic timetabling, there is an abuse of process and a contempt for scrutiny, coupled with Ministers playing fast and loose with a strict interpretation of the honest truth. For example, it is unusual for us to talk in the House about discussions between the usual channels, but I must refer to the comments made last night during the debate on the Tobacco Advertising and Promotion Bill by the Minister for Public Health. Replying to my hon. Friend the Member for South Dorset (Mr. Bruce), she said:
I have to tell the hon. Gentleman that the Government offered more time for debate in Committee, and if the Opposition had wanted to, they could have taken up that offer."—[Official Report, 13 February 2001; Vol. 363, c. 189.]
I am told that that is not true; no such offer was made through the usual channels. Having said that it was, the Minister needs to come back to the House and explain exactly what she meant by her words. Our use of the English dictionary would not show that an offer for more time was made in a way that we would normally understand.

Mr. John Bercow: I am somewhat surprised, as well as perturbed, by what my hon. Friend says about the Minister for Public Health. Is he aware that that statement by the hon. Lady is in stark contrast to, and incompatible with, what she previously told the House? Previously, she said that she had held no discussions with representatives of the Government Whips Office about the timetabling.

Dr. Fox: My hon. Friend makes a valuable and serious point. Those two statements seem mutually exclusive, and I am sure that he will carry out further investigations because the House will want to know the exact truth. We cannot have Ministers saying that discussions have taken place through the usual channels, which is how we maintain civilised relations and order in the House, when it appears that they have not taken place. That can only undermine confidence in those discussions.
The Government's ethos is one of intensely disliking scrutiny, and they do all that they can to avoid it. The Prime Minister's demeanour at Question Time shows that he regards Prime Minister's questions themselves as impertinent. That is shown in his answers as well as his body language. So that the Government are not scrutinised properly, they ensure that those Labour Members with strong views are not represented in Committee, which causes a further diminution of scrutiny.
During a point of order this afternoon, the hon. Member for Rotherham (Mr. MacShane) made it clear that some Government Back Benchers have not the faintest idea that one of their jobs is to scrutinise the Executive on behalf of their constituents, rather than simply being Lobby fodder and the Whips' poodles, which they are so often in the House.
The timetable motion is another example of the Government playing fast and loose with the House. They have tabled more than 120 amendments to the Bill since


the end of its consideration in Committee, and most of them were tabled at the last possible moment. They first appeared at 10.15 the night before last, and the explanatory notes were not available until last night. What are we to conclude from that?

Mr. Hogg: Is not the inevitable consequence of the timetable motion that many of those amendments will not be debated in the House? If they are debated at all, it will be in the other place. If amendments are made there, they will return to the House, probably on a timetable and so will never be debated in the House.

Dr. Fox: It is the ultimate irony that the Government, who came to office with open contempt for the other place, have now created arrangements whereby the electorate rely even more on the other place to scrutinise legislation, because we in this House are given so little time to do so by a Government who ruthlessly use their large parliamentary majority to restrict the time available. People outside want many issues to be debated today and there are many groups of amendments—for example, on medical, dental and pharmaceutical lists; on local authority overview; on patient information; on representation of patients and the community health councils; on nursing care; and on intervention orders.
A huge amount needs to be debated, but that will not happen not only because of the number of Members who want to take part, but because the Minister will have to do a great deal of explaining on the 120-odd amendments and new clauses that the Government have tabled to try to clarify their own Bill. What are we to conclude from the fact that they have tabled so many amendments and new clauses?

Mr. Fabricant: My hon. Friend will be only too aware that so many amendments were tabled to the Utilities Bill that, in the end, it was such a mess that half the Bill had to be discarded after a considerable waste of time. Is he aware that we have just five hours in which to discuss all nine groups of amendments that Mr. Speaker has selected? Perhaps the most important group, which concerns our constituents most of all, is that on the representation of patients and community health councils, which contains 22 amendments. My hon. Friend has correctly said that many amendments and new clauses will not even be discussed, but, by my simple calculation, we shall have less than a minute to discuss each amendment or new clause that is debated. Does he agree that that amount of time is inadequate?

Dr. Fox: My hon. Friend makes several important points, the first of which is that the problem is not confined to the Bill; it has occurred on numerous occasions. Secondly, good legislation requires a lot of scrutiny. No matter how recently hon. Members were elected, they will all know of legislation that would have been better if we had spent more time scrutinising it in greater detail. It is distressing that those of us who are elected to represent our constituents increasingly have to rely on an unelected Chamber to scrutinise legislation appropriately. That cannot be the correct constitutional balance. Major issues have been raised by the fact that the Government have sought to gag the elected House in a

way that they are, thankfully, incapable of doing with the unelected House. There is a gross imbalance in the way that we consider legislation.

Mr. David Hinchliffe: The Committee is one of the most important stages in the scrutiny of a Bill. Unlike me, the hon. Gentleman was a member of the Committee that considered this Bill, but how many Committee sittings did he actually attend?

Dr. Fox: I am afraid that, in addition to selling out on community health councils, the hon. Gentleman appears increasingly to be selling out to his Whips. The issue is how well the Bill was scrutinised in Committee and how much time was given to that. I have every confidence that my Front-Bench colleagues scrutinised the Bill in Committee better than I would have done. They did a magnificent job. The hon. Gentleman knows that there are major issues to be debated, so I am sorry that he has tried to sidetrack the House in a manner that is frivolous and unworthy of him.
The Government have clearly not thought through the issues. What are we to make of the fact that they have tabled so many new clauses and amendments? Does that mean that they had rot thought about possible problems before they introduced the Bill? That is probably part of the answer because we all know that, for all their talk of consultation, very lit le consultation took place with the groups that will be affected by the Bill. The Government probably did not think about the problems in advance.
Have so many new clauses and amendments been tabled because the Bill has been so poorly drafted? Where does the blame for that lie? Do Ministers and the Government take responsibility for any of their actions? Did Ministers miss things when they first read the Bill and did they fail to understand their own legislation? Does the number of consequential amendments that have been tabled suggest that Ministers did not understand the Bill's proposals, speedily drafted as it was? I suspect that all those issues contributed to the mess that we have to put right in a short time today.

Mr. Bercow: The point made by the hon. Member for Wakefield (Mr. Hinchliffe) was pitiful. It was unworthy of his status as Chairman of the Select Committee on Health. Will my hon. Friend confirm that the Secretary of State for Health did not sit and did not seek to sit either on the Standing Committee for this Bill or on that for the Tobacco Advertising and Promotion Bill? We do not particularly criticise him for that: he is very important, very senior, very respected and very busy and has a very full diary. However, my hon. Friend contributed intelligently to the Committee, and he was aided and abetted by my hon. Friends the Members for Runnymede and Weybridge (Mr. Hammond) and for Meriden (Mrs. Spelman). It ill behoves the hon. Member for Wakefield to make such a cheap, invalid and thoroughly bogus criticism.

Dr. Fox: Yes, and I have no intention of continuing the debate on this point. We all understand that the Secretary of State is far too important to take part in the scrutiny of his or any other legislation. He is above the normal tasks that the House carries out, and it is far more important these days for Secret tries of State simply to make sure


that they are fully available for the photo-opportunities, headlines and soundbites that an the Government's hallmark.
I wonder whether the Bill has been made up as it went along. The strong impression that was given to us in Committee was that Ministers math up their answers as they went along. In the debate on what was clause 59 and is now clause 62, the Government presented information to the Committee as they went along and no notice of it was given in advance. It related to whole new structures for which no explanatory notes were given to members of the Committee. We were working entirely in the dark during our consideration of some q if the Government's most major reforms. Ministers simply seemed to change tack according to the questions that were asked and as notes were passed from civil servants. That is an extraordinarily unsatisfactory way to consider legislation. However, I am afraid that it is not unusual.
This is a hugely centralising and authoritarian Bill. It will give the Secretary of State enormous powers to hire and fire NHS staff. He can fire certain staff at will and replace them with any staff that he wants, but he had the nerve to say on Second Reading that this was a devolving Bill. It could not be more different from a devolving Bill; it is the diametric opposite.
When we considered the community health councils, the Government came up with all thy nonsense about how they had consulted. However, there was no consultation before the Bill's publication, and the Prime Minister and the Secretary of State had to eat if Lot humble pie—I am sure that would have been too indigestible for them—at least their words.
A centralising measure on patient information was also introduced. It will allow the Secretary of State to control information in a hitherto unprecedented way. Almost every group with an interest in health care which wrote to Committee members and wanted to have their voices heard opposed that measure, bin debate on it was curtailed, as it will be today.
Ministers never consider the effect of restricting the length of time between Committee and Report, and between the tabling of amendments and new clauses and their consideration on the Floor of the House. It is not only Members of Parliament who do not have time to research their implications and to get proper legal advice on their impact; outside bodies that have a great interest in the Bill also do not have the time to work out what they entail. They are unable to determine what effect amendments and new clauses might have or to pass information and advice on to Members of the House and Committee members, so that we know how they want us to proceed.
The Government have no time for us, the House, the process of Parliament, the due process of scrutiny or the outside bodies that want to make representations. All those are cavalierly swept away so that the Government can stick to their timetable and complete their legislation, irrespective of its quality. We are being driven entirely by the Government's desire to clear the decks for a general election. The quality of legislate ln is not the main consideration.
In all probability, we will have an hour on Third Reading, which is ridiculous. Any hon. Member who scans Hansard will see that it is traditional for Third Reading to be a shorter part of the scrutiny process.

We should devote more time to other aspects of scrutiny. Third Reading deals with the Bill's generalities, but we will fail properly to scrutinise its detail, which will ultimately decide whether we produce satisfactory legislation. All in all, it is an extremely unsatisfactory process from a very unsatisfactory Government who are, for internal reasons, happy to give us unsatisfactory law.

Dr. Peter Brand: Liberal Democrats do not usually approve of wasting time on programme motions, but it is important to make a few points now.
The Committee stage was useful because it became clear that some of the Bill needs to be rewritten. So many issues were raised that Ministers agreed that they needed to be addressed. However, instead of a proper rethink and rewrite, the Bill has become more complicated in terms of drafting and the extra bodies that are being introduced. Not only do we have a problem of too little time between Committee and Report, but the Government have been unwise to introduce some of the measures.
In Committee, the Minister told us that the working party, which has been beavering away on patient confidentiality for, I think, two years, will be reporting in the autumn; yet we are being invited today to pass legislation to cover that issue. We were also told that a proper complaints and advocacy procedure for patients is about to be announced, yet we are being asked to approve legislation today that is intimately involved with that procedure. In addition, the Prime Minister told the House today that the Government are still consulting on the future of community health councils. That is a short consultation, because we are legislating on that matter today.
I do not like to waste time—it would be better to use it to discuss the amendments—but the Government are unwise to legislate now on at least those three issues. The Bill started as a curate's egg, but has turned out to be a dog's breakfast.

Sir George Young: I support my hon. Friend the Member for Woodspring (Dr. Fox) in opposing the motion. I am not fundamentally opposed to all programme motions. I know that some of my hon. Friends are against them all, and I respect that view. I do not share that view, and there have been occasions when I have put my name to programme motions. I did so because I felt that that was in the best interests of a structured debate, sometimes with benefits to the Opposition. However, I am in favour of programme motions only when they do justice to the issues under discussion and give the House an adequate opportunity to scrutinise them. That is not the position this afternoon.
There are three reasons—the Minister did not deal with them—why the motion is particularly inappropriate. One reason relates to community health councils. Much concern was expressed on Second Reading about CHCs. My hon. Friend the Member for Eddisbury (Mr. O'Brien) initiated a debate in Westminster Hall. There were meetings in Committee Rooms that were well attended by hon. Members from both sides of the House.
For whatever reason—I make no complaint about the Committee of Selection—no Labour Members were notable critics of the Government's policies on CHCs. 


Their only opportunity to voice their concern will be this afternoon. I am sure that, as we speak, Labour Members are in the Central Lobby, from where I have just returned after a constructive dialogue with the Winchester CHC, being briefed about the damage that the Government propose to do to CHCs. I would be amazed if many Labour Members did not wish to speak later on behalf of their CHCs and register their concern at what is about to happen.

Dr. Fox: Given the Prime Minister's indication at Question Time that the Government may be intending to make a partial U-turn, does my right hon. Friend agree that in the light of the discussions in defence of the Government's original proposals in Committee, in which the Minister of State participated, it would be unacceptable to have any new Government ideas being put briefly to the House this evening? We would be unable fully to scrutinise what the Government intend to do. That opportunity should be available to us in Committee.

Sir George Young: If the Government are about to make a major change in their policy on CHCs, that could not be accommodated within the programme motion, which was tabled before such a U-turn was contemplated. That would be an injustice to the House.
The second reason—

Ms Linda Perham: The right hon. Gentleman commented on Labour Members speaking on behalf of community health councils. Does he remember that on Second Reading I spoke on behalf of Redbridge CHC and my hon. Friend the Member for Romford (Mrs. Gordon) spoke on behalf of the CHC in her constituency? We put forward our views on Second Reading.

Sir George Young: We were sorry not to see the hon. Lady and the hon. Member for Romford (Mrs. Gordon) in Committee, where their concerns were not done justice by the Labour Members who served on it.

Mr. Bercow: The hon. Member for Ilford, North (Ms Perham) has made a challenging and important point. Does my right hon. Friend agree that although she and the hon. Member for Romford (Mrs. Gordon) bravely and eloquently criticised the Government's policy on CHCs on Second Reading, that does not remove or diminish their responsibility, if the Government have not responded to that concern, to repeat their criticism in even more forceful terms?

Sir George Young: The House awaits the hon. Lady's speech with bated breath.
My second reason for thinking that the Government are wrong was touched on by my hon. Friend the Member for Woodspring, and it is the number of Government amendments. There are 15 pages of Government amendments to an 80-page Bill, yet they seriously expect us to consider these matters in the time that remains available, which is about four and a half hours. It is impossible for us to consult the bodies that are interested

in the Bill during that time, given the range of amendments that have been tabled. Thirdly, a 9 pm cut-off does not allow adequate time to conclude our consideration, given the important issues that the Bill tackles. For example there is the establishment of care trusts, with all the implications for social services.
My interest in speaking on the motion is that the final group of amendments on Report are in my name. I am concerned that, given the time frame, we may not reach that group.

Mr. Hogg: Perhaps my right hon. Friend will remind the House that there is no reason why we should finish at 10 pm. Last night, we continued until 12 midnight on a Government Bill. The Government were content to allow the House to debate the complications of the Capital Allowances Bill between 10 pm and 12 midnight. Why should we not do the same with today's Bill?

Sir George Young: I am sure that the Minister will deal with that when he replies. My right hon. and learned Friend said that there is no reason why we should not go beyond 10 o'clock but, as he knows, that is what the programme motion says. If it is carried, we will have to stop at 10 o'clock. Health councils, patient information—dealt with in clause 61I, which was previously clause 59—the new regime for prescribing, important changes for residential and nursing homes and the new changes to capital limits are important issues in the Bill to which the House will not be able to do justice by 9 o'clock.
That is symptomatic of the mismanagement of the Government's legislative programme. They are simply trying to get too many Bills through in too short a time. The House cannot do justice to the sheer volume of legislation with which it is confronted. Within their programme, the Government have mismanaged matters because this Bill comes after the Hunting Bill. It is clear that the Hunting Bill will not reach the statute book, but it is conceivable that this Bill could. If the Government had put it ahead of the Hunting Bill, we would not be facing this programme motion and we would have had more time to discuss the Bill.
I want to register my protest against the programme motion. I shall follow my hon. Friend the Member for Woodspring into the Lobby with enthusiasm.

Mr. Simon Thomas: I, too, want to speak briefly against the programme motion. I am not opposed to modernisation or the timetabling of Bills, and I have supported programme motions when I felt that sufficient time and consultation had been allowed. However, it is clear that we do not have enough time to scrutinise the details of this Bill before 9 o'clock.
I was concerned or Monday when I saw that so many Government amendments had been tabled. I was interested in the details of the Opposition's amendments and to see what important issues they brought out. I am also concerned that no Member from Wales served on the Standing Committee. That issue needs to be addressed by the usual channels, whoever they are, because no Welsh Member, whether from the Government or the Opposition, was on the Committee.
The Bill will have a huge impact on Wales. Of course, Wales is keeping community health councils—the National Assembly has already consulted on the matter and decided to keep them.

Mr. Hogg: Will the hon. Gentleman remind the House and, through it, the wider community that a Bill's Report stage is the only occasion when Members as a whole have an opportunity to address its details? As there were no Welsh Members in Committee, that Report stage is the only occasion when Members who represent Welsh constituencies can debate the detail of the Bill. They are being prevented from doing that by the Government.

Mr. Thomas: I agree with the right hon. and learned Gentleman, which is why I oppose the programme motion.
As I was about to say, last week Me National Assembly for Wales announced the principles of its national plan for the health service in Wales. That raises many issues which should be debated in the context of the Bill, such as the abolition of health authorities in Wales and the fact that many people in Wales want CHCs to be improved, not abolished. There is a moot question whether the Bill allows Wales to change CHCs in a positive way, not merely retain or abolish them. These is also the question of long-term care for the elderly, which now faces people in Wales as, previously, it faced people in Scotland.

Dr. Brand: I am sure that my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) is too modest to point out to the hon. Gentleman that he had to make the case for giving powers to the National Assembly for Wales to make its own decisions on matters such as personal care and nursing.

Mr. Thomas: I am grateful for I hat information. I am sure that many hon. Members do not forget Wales. My point is that we need Members front Wales to ensure that all the issues are put across. I am sure that the hon. Member for Sutton and Cheam (Mr. Burstow) did his best, but it is important that we acknowledge that, on Report, ordinary Back-Bench Members have an opportunity to scrutinise legislation and to support or oppose individual amendments.
My particular concern is that the worthy and correct debate that we will have on CHCs it England, which may not affect people in Wales as much, will take up so much time—as it should—that we will not have time for the full debate that we need on new clause 3 and the definition of nursing versus personal care. With all due respect to those who have been so concerned about community health councils, to me an even greater issue in the long term is how we look after the increasing elderly population in the United Kingdom. We may run up Against the buffers of 9 pm while we are discussing that.
Although I feel quite warm towards much of what the Government do in the name of modernisation, I do not believe that modernisation should equate to a lack of time for scrutiny of any aspect of legislation. Because I do not think that we will have sufficient time for scrutiny on Report, I shall oppose the programme motion.

Mr. Richard Shepherd: I commend to the Leader of the House the speeches that have been made on the guillotine motion. The motion is in the name of the Leader of the House and the Secretary of State for Health, neither of whom had the courtesy to move the motion personally, although it touches on the principal reason why we are in this place: the scrutiny of legislation and the holding of Governments to account. The motion needed the authority of a Cabinet member.
My objection is similar to that of my hon. Friends, but it is wider ranging. Since the Queen's Speech, all Bills have been treated to the guillotine procedure. It is a new procedure, brought in only by a Government majority imposing a new system on the House. My opposition to guillotines goes back a long time. It came about when I first perceived the guillotine as the means by which the Executive could govern the House more totally than it had ever been governed in the past. I used to keep count of the number of guillotines imposed under Mrs. Thatcher—39 or possibly 41; my memory may not be accurate. This Government have been responsible for many more guillotines than were ever envisaged in the 11 years of Mrs. Thatcher.
Under the new device, everything is to be guillotined. Behind that is a Modernisation Committee assumption, which appeared in the first report of that Committee: the Government are entitled to get their business. That was repeated in the Modernisation Committee report that initiated the train of guillotines. It is an entirely new constitutional proposition that a Government are entitled to get their business. That, effectively, is what the guillotine motion states. Scrutiny is not required-the only condition is that the Government have a majority.
The use of the guillotine procedure is a celebration of majoritarianism. The due process by which we achieve consent and acquiescence is thrown out of the window. It does not matter what the Opposition say, because the Government majority will prevail. The logical next step in new Labour's thinking is, "Why do we bother listening to what others say? We have the majority." That view was well expressed by the Leader of the House on Monday and by her one machine gunner in support of that proposition, when Chairmen and members of Select Committees presented their views on the report, "Shifting the Balance".
The Government are increasing their power and their contempt for the House of Commons through motions such as this and the Standing Orders that inform them. It is a denial of the purpose and function of the House of Commons. Ministers who were in opposition for many years know that I say that genuinely. Their views when they were in opposition were an important part of forming public opinion and testing whether the public gave its consent and acquiescence to the measure in question.
The subject of the Bill, community health, is particularly important to many of us. Earlier, we all watched the Prime Minister dancing, yet again. I never know whether he is making a journey between fantasy, half-remembrance and retrieved memories, or just making it up as he goes along. We half expect an announcement of some concession on community health. Whether that can be incorporated into the Bill when a consultation process is still under way raises another question: what is the purpose of legislating on Wednesday, only for the


House of Lords to accommodate further changes at a later stage, following the completion of that quiet consultation process?

Dr. Howard Stoate: The hon. Gentleman rails against the Government for using their democratically elected majority to get their business through the House. Does he also rail against the other place for using its huge undemocratically elected majority to hold up business?

Mr. Shepherd: A majority ultimately comes into play, but let us be clear that we are discussing the process. That process, which the motion tries to deny, involves the rights of Members—who represent diverse communities—and their only opportunity, if they are not members of a Standing Committee, to discuss the issues that they deem to be important. That is called process, but the new system has effectively eliminated it.
As a member of the Modernisation Committee, I know that there is great concern about the arrangements, the way in which they are dumped on to the House and the contempt that they bring to it. There is also anxiety that they do not satisfy the one genuine cry of many new Labour Members: "Can we not go home earlier?" I happen to respect that cry. I am not sure why hon. Members should be in the Chamber at midnight when we could start at 9 am, but it was the Government who did not want us to start earlier.

Dr. Fox: I have a further point in line with what my hon. Friend is saying. The Government might cave in to some extent today on community health councils, but there will be restricted time for consideration of any new proposals. Not only will we have little time at this sitting, if the proposals are amended in the other place our consideration will be guillotined yet again, which will be a double insult to us and to our constituents.

Mr. Shepherd: That is the essence of the point that I am trying to make. The Government are not interested in the process or in the fact that we may or may not discuss these matters. No Government should consciously impose an absurd guillotine such as that in the motion—and the motion is not isolated; it is part of the Labour Government's consistent policy to relegate the proper processes within which we try to represent our electorate. There is no question about that.
The Government now try to make us use polite terms such as "programme motion". I notice that that has worked with some hon. Members, even on the Conservative Front Bench. I think that it was an American politician who said that if it squawks like a duck, walks like a duck and looks like a duck, then it is a duck. We are considering a guillotine motion. I reiterate that no Government can sustain themselves in the regard of the people when they treat elected representatives in such a manner. That does not apply only to Conservative Members, as the Government are doing the same to their Back Benchers, some of whom, through lack of experience or wide-eyed optimism, hope that all will come right.
We have a purpose that survives beyond the existence of individual Governments and Parliaments. It is a continuing theme of the British people that they are properly represented and that their elected representatives can speak honourably and openly on the issues of the day.

Mr. Michael Fabricant: I support my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd), who spoke with considerable passion. I want to speak not about the constitutional issues, but merely the practical issues raised by the programme motion—or the guillotine, as my hon. Friend called it.
Mr. Speaker has selected nine groups of amendments and new clauses for debate in only five—or maybe four—short hours. That is half an hour per grouping. We have already established that the group that relates to community health councils, which has the heading "Representation of patients", contains 22 amendments and new clauses.

Dr. Fox: Twenty-three.

Mr. Fabricant: It contains 23 amendments and new clauses, as my hon. Friend points out. It includes some Government amendments. which were presumably tabled because Labour Members learned in Committee that the Bill was incomplete, incorrect or flawed.
Surely the point of scrutiny on the Floor of the House is to enable us, through the democratic process, not only to oppose clauses with which we disagree but to improve the Bill, to ensure that it is not flawed and that drafting errors that may remain after consideration in Committee can be corrected. The Conservative party does not oppose every aspect of the Bill
The programme motion, which will be accepted because the Government will force it through with their huge majority, does not time the debates on the amendment groupings. As the hon. Member for Ceredigion (Mr. Thomas), who represents Plaid Cymru and many Welsh people, said, we may spend time debating representation of patients and community health councils but not even reach the amendments on nursing care and personal care, which are important to many elderly patients. Elderly people now comprise 40 per cent. of the population.
The programme motion is facile; it is an insult to Parliament and the House of Commons; and, worse, it is an insult to the people; of Britain.

Mr. Tony Baldry: The Government's Achilles heel is arrogance. The speed with which they took the Bill through Committee demonstrates that. Second Reading occurred on 10 January; barely a month later, on 14 February, we have reached Report. Yet the Bill has 70 clauses, six schedules—

It being forty-five minutes after the commencement of proceedings on the notion, MADAM DEPUTY SPEAKER put the Question, pursuant to Order [7 November 2000].

The House divided. Ayes 342, Noes 181.

Division No. 123]
[4.42 pm


AYES


Adams, Mrs Irene (Paisley N)
Cranston, Ross


Ainger, Nick
Crausby, David


Ainsworth, Robert (Cov?try NE)
Cryer, John (Hornchurch)


Allen, Graham
Cummings, John


Anderson, Rt Hon Donald (Swansea E)
Cunningham, Rt Hon Dr Jack (Copeland)


Anderson, Janet (Rossendale)
Cunningham, Jim (Cov'try S)


Armstrong, Rt Hon Ms Hilary
Curtis-Thomas, Mrs Claire


Atkins, Charlotte
Dalyell, Tam


Austin, John
Darling, Rt Hon Alistair


Bailey, Adrian
Davey, Valerie (Bristol W)


Barnes, Harry
Davidson, Ian


Battle, John
Davies, Rt Hon Denzil (Llanelli)


Bayley, Hugh
Davies, Geraint (Croydon C)


Beard, Nigel
Davis, Rt Hon Terry (B'ham Hodge H)


Beckett, Rt Hon Mrs Margaret



Begg, Miss Anne
Dawson, Hilton


Bell, Stuart (Middlesbrough)
Denham, Rt Hon John


Benn, Hilary (Leeds C)
Dismore, Andrew


Bennett, Andrew F
Dobbin, Jim


Benton, Joe
Dobson Rt Hon Frank


Bermingham, Gerald
Donohoe, Brian H


Berry, Roger
Doran, Frank


Best, Harold
Dowd, Jim


Betts, Clive
Drew, David


Blackman, Liz
Drown, Ms Julia


Blair, Rt Hon Tony
Dunwoody, Mrs Gwyneth


Blears, Ms Hazel
Eagle, Angela (Wallasey)


Blizzard, Bob
Eagle, Maria (L'pool Garston)


Blunkett, Rt Hon David
Edwards, Huw


Boateng, Rt Hon Paul
Efford, Clive


Borrow, David
Ellman, Mrs Louise


Bradley, Peter (The Wrekin)
Ennis, Jeff


Bradshaw, Ben
Etherington, Bill


Brinton, Mrs Helen
Field, Rt Hon Frank


Brown, Rt Hon Gordon (Dunfermline E)
Fisher, Mark



Fitzpatrick, Jim


Brown, Rt Hon Nick (Newcastle E)
Fitzsimons, Mrs Lorna


Brown, Russell (Dumfries)
Flint, Caroline


Browne, Desmond
Flynn, Paul


Buck, Ms Karen
Foster, Rt Hon Derek


Burden, Richard
Foster, Michael Jabez (Hastings)


Burgon, Colin
Foulkes George


Byers, Rt Hon Stephen
Fyfe, Maria


Caborn, Rt Hon Richard
Galloway, George


Campbell, Mrs Anne (C'bridge)
Gapes, Mike


Campbell, Ronnie (Blyth V)
George, Rt Hon Bruce (Walsall S)


Campbell-Savours, Dale
Gerrard, Neil


Cann, Jamie
Gibson, Dr Ian


Caplin, Ivor
Gilroy, Mrs Linda


Casale, Roger
Goggins Paul



Cawsey, Ian
Griffiths, Jane (Reading E)


Chapman, Ben (Wirral S)
Griffiths, Nigel (Edinburgh S)


Chaytor, David
Griffiths, Win (Bridgend)


Clapham, Michael
Grocott, Bruce


Clark, Rt Hon Dr David (S Shields)
Grogan, John


Clark, Paul (Gillingham)
Gunnell, John


Clarke, Charles (Norwich S)
Hain, Peter


Clarke, Eric (Midlothian)
Hall, Mike (Weaver Vale)


Clarke, Rt Hon Tom (Coatbridge)
Hamilton, Fabian (Leeds NE)


Clarke, Tony (Northampton S)
Hanson, David


Clelland, David
Harman, Rt Hon Ms Harriet


Coaker, Vernon
Healey, John


Coffey, Ms Ann

Henderson, Doug (Newcastle N)


Cohen, Harry
Henderson, Ivan (Harwich)


Coleman, Iain
Hendrick, Mark


Colman, Tony
Hepburn Stephen


Connarty, Michael
Heppell, John


Cooper, Yvette
Hesford, Stephen


Corbett, Robin
Hewitt, Ms Patricia


Corbyn, Jeremy
Hill, Keith


Cousins, Jim
Hinchliffe, David


Cox, Tom
Hodge, Ms Margaret





Hoey, Kate
Marshall, Jim (Leicester S)


Hood, Jimmy
Marshall-Andrews, Robert


Hope, Phil
Martlew, Eric


Hopkins, Kelvin
Meacher, Rt Hon Michael


Howarth, Rt Hon Alan (Newport E)
Meale, Alan


Howarth, George (Knowsley N)
Merron, Gillian


Howells, Dr Kim
Michael, Rt Hon Alun


Hoyle, Lindsay
Michie, Bill (Shef'ld Heeley)



Hughes, Ms Beverley (Stretford)
Milburn, Rt Hon Alan


Hughes, Kevin (Doncaster N)
Miller, Andrew


Humble, Mrs Joan
Mitchell, Austin


Hurst, Alan
Moffatt, Laura


Hutton, John
Morgan, Ms Julie (Cardiff N)


Iddon, Dr Brian
Morris, Rt Hon Ms Estelle (B'ham Yardley)


Illsley, Eric



Ingram, Rt Hon Adam
Morris, Rt Hon Sir John (Aberavon)


Jackson, Ms Glenda (Hampstead)



Jackson, Helen (Hillsborough)
Murphy, Denis (Wansbeck)


Jenkins, Brian
Murphy, Jim (Eastwood)


Johnson, Alan (Hull W & Hessle)
Murphy, Rt Hon Paul (Torfaen)


Jones, Rt Hon Barry (Alyn)
Naysmith, Dr Doug


Jones, Mrs Fiona (Newark)
Norris, Dan


Jones, Helen (Warrington N)
O'Brien, Bill (Normanton)


Jones, Ms Jenny (Wolverh'ton SW)
O'Brien, Mike (N Warks)



O'Hara, Eddie


Jones, Jon Owen (Cardiff C)
Olner, Bill


Jones, Dr Lynne (Selly Oak)
O'Neill, Martin


Jones, Martyn (Clwyd S)
Organ, Mrs Diana


Jowell, Rt Hon Ms Tessa
Palmer, Dr Nick


Joyce, Eric
Pearson, Ian


Kaufman, Rt Hon Gerald
Perham, Ms Linda


Keeble, Ms Sally
Pickthall, Colin


Keen, Alan (Feltham & Heston)
Pike, Peter L


Keen, Ann (Brentford & Isleworth)
Pond, Chris


Kelly, Ms Ruth
Pound, Stephen


Kemp, Fraser
Prentice, Ms Bridget (Lewisham E)


Kennedy, Jane (Wavertree)
Prentice, Gordon (Pendle)


Kidney, David
Prescott, Rt Hon John


Kilfoyle, Peter
Primarolo, Dawn


King, Andy (Rugby & Kenilworth)
Prosser, Gwyn


Kumar, Dr Ashok
Purchase, Ken


Ladyman, Dr Stephen
Quin, Rt Hon Ms Joyce


Lammy, David
Quinn, Lawrie


Lawrence, Mrs Jackie
Radice, Rt Hon Giles


Laxton, Bob
Rammell, Bill


Lepper, David
Rapson, Syd


Levitt, Tom
Raynsford, Nick


Lewis, Ivan (Bury S)
Reed, Andrew (Loughborough)


Linton, Martin
Robertson, John (Glasgow Anniesland)


Lock, David



Love, Andrew
Roche, Mrs Barbara


McAvoy, Thomas
Rogers, Allan


McCabe, Steve
Rooker, Rt Hon Jeff


McCartney, Rt Hon Ian (Makerfield)
Rooney, Terry



Ross, Ernie (Dundee W)


McDonagh, Siobhain
Rowlands, Ted


Macdonald, Calum
Roy, Frank


McDonnell, John
Ruane, Chris


McFall, John
Ruddock, Joan


McGrady, Eddie
Russell, Ms Christine (Chester)


McGuire, Mrs Anne
Ryan, Ms Joan


McIsaac, Shona
Salter, Martin


McKenna, Mrs Rosemary
Sarwar, Mohammad


Mackinlay, Andrew
Savidge, Malcolm


McNamara, Kevin
Sawford, Phil


McNulty, Tony
Sedgemore, Brian


MacShane, Denis
Sheerman, Barry


Mactaggart, Fiona
Sheldon, Rt Hon Robert


McWalter, Tony
Shipley, Ms Debra


McWilliam, John
Singh, Marsha


Mahon, Mrs Alice
Skinner, Dennis


Mallaber, Judy
Smith, Rt Hon Andrew (Oxford E)


Mandelson, Rt Hon Peter
Smith, Angela (Basildon)


Marsden, Gordon (Blackpool S)
Smith, Rt Hon Chris (Islington S)


Marsden, Paul (Shrewsbury)
Smith, Miss Geraldine (Morecambe & Lunesdale)


Marshall, David (Shettleston)







Smith, Jacqui (Redditch)
Turner, Neil (Wigan)


Smith, John (Glamorgan)
Twigg, Derek (Halton)


Soley, Clive
Twigg, Stephen (Enfield)


Southworth, Ms Helen
Tynan, Bill


Spellar, John
Vaz, Keith


Squire, Ms Rachel
Vis, Dr Rudi


Starkey, Dr Phyllis
Walley, Ms Joan


Steinberg, Gerry
Ward, Ms Claire


Stewart, David (Inverness E)
Wareing, Robert N



Stewart, Ian (Eccles)
Watts, David


Stinchcombe, Paul
White, Brian


Stoate, Dr Howard
Whitehead, Dr Alan


Strang, Rt Hon Dr Gavin

Wicks, Malcolm


Stringer, Graham
Williams, Rt Hon Alan (Swansea W)


Stuart, Ms Gisela



Sutcliffe, Gerry
Williams, Alan W (E Carmarthen)


Taylor, Rt Hon Mrs Ann (Dewsbury)
Williams, Mrs Betty (Conwy)



Wills, Michael


Taylor, Ms Dari (Stockton S)
Winnick, David



Taylor, David (NW Leics)
Winterton, Ms Rosie (Doncaster C)


Temple-Morris, Peter
Woodward, Shaun


Thomas, Gareth R (Harrow W)
Woolas, Phil


Timms, Stephen
Wray, James


Tipping, Paddy
Wright, Anthony D (Gt Yarmouth)


Todd, Mark
Wright, Tony (Cannock)


Touhig, Don
Wyatt, Derek


Trickett, Jon



Turner, Dennis (Wolverh'ton SE)
Tellers for the Ayes:


Turner, Dr Desmond (Kemptown)
Mr. Greg Pope and


Turner, Dr George (NW Norfolk)
Mr. David Jamieson.




NOES


Ainsworth, Peter (E Surrey)
Cunningham, Ms Roseanna (Perth)


Allan, Richard



Amess, David
Curry, Rt Hon David


Ancram, Rt Hon Michael
Davey, Edward (Kingston)


Arbuthnot, Rt Hon James
Davies, Quentin (Grantham)


Ashdown, Rt Hon Paddy
Davis, Rt Hon David (Haltemprice)


Atkinson, Peter (Hexham)
Donaldson, Jeffrey


Baker, Norman
Duncan, Alan


Baldry, Tony
Emery, Rt Hon Sir Peter


Ballard, Jackie
Evans. Nigel


Beggs, Roy
Faber. David


Berth, Rt Hon A J
Fabricant, Michael


Bell, Martin (Tatton)
Fallon, Michael


Bercow, John
Fearn, Ronnie


Beresford, Sir Paul
Flight, Howard


Blunt, Crispin
Forth Rt Hon Eric


Body, Sir Richard
Foster, Don (Bath)


Boswell, Tim
Fowler, Rt Hon Sir Norman


Bottomley, Peter (Worthing W)
Fox, Dr. Liam


Bottomley, Rt Hon Mrs Virginia
Gale, Roger


Brady, Graham
Garnier, Edward


Brake, Tom
Gibb, Nick



Gidley, Sandra


Brand, Dr Peter
Gillan, Mrs Cheryl


Brazier, Julian
Gray, James


Breed, Colin
Green, Damian


Brooke, Rt Hon Peter
Greenway, John


Browning, Mrs Angela
Grieve, Dominic


Bruce, Malcolm (Gordon)
Gummer, Rt Hon John


Burnett, John
Hague, Rt Hon William


Burns, Simon
Hamilton, Rt Hon Sir Archie


Burstow, Paul
Hammond, Philip


Butterfill, John
Hancock, Mike


Cable, Dr Vincent
Harris, Dr Evan


Cash, William
Harvey, Nick


Chapman, Sir Sydney (Chipping Barnet
Hayes, John



Heald, Oliver


Chidgey, David
Heath, David (Somerton & Frome)


Chope, Christopher
Heathcoat-Amory, Rt Hon David


Clark, Dr Michael (Rayleigh)
Hogg, Rt Hon Douglas


Collins, Tim
Horam, John


Cormack, Sir Patrick
Howard, Rt Hon Michael


Cotter, Brian
Howarth, Gerald (Aldershot)


Cran, James
Hughes, Simon (Southwark N)





Hunter, Andrew
Redwood, Rt Hon John


Jack, Rt Hon Michael
Rendel, David


Jackson, Robert (Wantage)
Robertson, Laurence (Tewk'b'ry)


Jenkin, Bernard
Roe, Mrs Marion (Broxbourne)


Johnson Smith, Rt Hon Sir Geoffrey
Russell, Bob (Colchester)



St Aubyn, Nick


Jones, Nigel (Cheltenham)
Sanders, Adrian


Keetch, Paul
Sayeed, Jonathan


Kennedy, Rt Hon Charles (Ross Skye & Inverness W)
Shephard, Rt Hon Mrs Gillian



Shepherd, Richard


Key, Robert
Simpson, Keith (Mid-Norfolk)


King, Rt Hon Tom (Bridgwater)
Smith, Sir Robert (W Ab'd'ns)


Kirkbride, Miss Julie
Smyth, Rev Martin (Belfast S)


Laing, Mrs Eleanor
Soames, Nicholas


Lait, Mrs Jacqui
Spelman, Mrs Caroline


Lansley, Andrew
Spring, Richard


Leigh, Edward
Stanley, Rt Hon Sir John


Letwin, Oliver
Steen, Anthony


Lewis, Dr Julian (New Forest E)
Streeter, Gary


Lidington, David
Stunell, Andrew


Lilley, Rt Hon Peter
Swayne, Desmond


Livsey, Richard
Syms, Robert


Lloyd, Rt Hon Sir Peter (Fareham)
Taylor, Ian (Esher & Walton)


Loughton, Tim
Taylor, Rt Hon John D (Strangford)


Lyell, Rt Hon Sir Nicholas
Taylor, John M (Solihull)


MacGregor, Rt Hon John
Taylor, Matthew (Truro)


McIntosh, Miss Anne
Taylor, Sir Teddy


MacKay, Rt Hon Andrew
Thomas, Simon (Ceredigion)


Maclean, Rt Hon David
Thompson, William


McLoughlin, Patrick
Tonge, Dr Jenny


Major, Rt Hon John
Trend, Michael


Malins, Humfrey
Tyler, Paul


Maples, John
Viggers, Peter


Mates, Michael
Walter, Robert


Maude, Rt Hon Francis
Waterson, Nigel


Mawhinney, Rt Hon Sir Brian
Webb, Steve


May, Mrs Theresa
Whitney, Sir Raymond


Michie, Mrs Ray (Argyll & Bute)
Whittingdale, John


Moore, Michael
Widdecombe, Rt Hon Miss Ann



Moss, Malcolm
Wilkinson, John


Nicholls, Patrick
Willetts, David


Norman, Archie
Willis, Phil


Oaten, Mark
Wilshire, David


O'Brien, Stephen (Eddisbury)
Winterton, Mrs Ann (Congleton)


Öpik, Lembit
Winterton, Nicholas (Macclesfield)


Ottaway, Richard
Yeo, Tim


Page, Richard
Young, Rt Hon Sir George


Pickles, Eric



Portillo, Rt Hon Michael
Tellers for the Noes:


Prior, David
Mr. Peter Luff and


Randall, John
Mr. Geoffrey Clifton-Brown.

Question accordingly agreed to.

Ordered,
That the following provisions shall apply to the Health and Social Care Bill for the purpose of supplementing the Order of 10th January:

Consideration and Third Reading

1. Proceedings on Consideration and Third Reading shall be completed at today's sitting.

2. Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion at Nine o'clock.

3. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at Ten o'clock.

4. Sessional Order B (Programming Committees) made by the House on 7th November 2000 shall not apply to proceedings on Consideration and Third Reacting.

Consideration of Lords Amendments and further messages from the Lords

5. Paragraphs (6) and (7) of Sessional Order A (varying and supplementing programme motions) made by the House on 7th November 2000 shall not apply to proceedings on any programme motion to supplement this order or to vary it in relation to—

(a) proceedings on Consideration a Lords Amendments; or
(b) proceedings on any further messages from the Lords, and the question on any such motion shall be put forthwith.

Orders of the Day — Health and Social Care Bill

As amended in the Standing Committee, considered.

New Clause 11

ENHANCED CRIMINAL RECORD CERTIFICATES

'.—(1) Section 115 of the Police Act 1997 (enhanced criminal record certificates) shall be amended as follows.

(2) In subsection (2)—

(a) the word "or" after paragraph (a) shall be omitted; and
(b) at the end of paragraph (b) there shall be inserted "or
(c) in relation to an individual to whom subsection (6C), (6D) or (6E) applies."

(3) After subsection (6B) there shall be inserted—

"(6C) This subsection applies to an individual included or seeking inclusion in any list prepared for the purposes of Part II of the National Health Service Act 1977 of—

(a) medical practitioners undertaking to provide general medical services,
(b) persons undertaking to provide general dental services,
(c) persons undertaking to provide general ophthalmic services, or
(d) persons undertaking to provide pharmaceutical services.

(6D) This subsection applies to an individual who is—

(a) a director of a body corporate included or seeking inclusion in a list referred to in subsection (6C)(b) or (c),
(b) a member of a limited liability partnership included or seeking inclusion in a list referred to in subsection (6C)(c),
(c) a member of the body of persons controlling a body corporate (whether or not a limited liability partnership) included or seeking inclusion in a list referred to in subsection (6C)(d).

(6E) This subsection applies to an individual included or seeking inclusion in any list prepared by a Health Authority under—

(a) section 28DA of the National Health Service Act 1977 or section 8ZA of the National Health Service (Primary Care) Act 1997 (lists of persons who may perform personal medical services or personal dental services), or
(b) section 43D of the 1977 Act (supplementary lists), and to an individual included or seeking inclusion in any list corresponding to a list referred to in paragraph (a) prepared by a Health Authority by virtue of regulations made under section 43 of the Health and Social Care Act 2001 (which provides for the application of enactments in relation to local pharmaceutical services).".'.—[Mr. Denham.]

Brought up, and read the First time.

The Minister of State, Department of Health (Mr. John Denham): I beg to move, That the clause be read a Second time.

Madam Deputy Speaker (Mrs. Sylvia Heal): With this it will be convenient to discuss the following: Government new clause 12—Conditional inclusion in medical, dental, ophthalmic and pharmaceutical lists.
Government amendments Nos. 40 to 109.

Amendment No. 32, in clause 28, page 31, line 11, at end insert—
'(7) Before making regulations under this section the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing personal medical services or personal dental services as the case may be.'.

Government amendments Nos. 110 to 113.

Amendment No. 31, in clause 34, page 36, line 27, at end insert— 
'(4) If the relevant authority makes a direction to a Health Authority under subsection (3) it shall make directions at the same time requiring the Health Authority to contract with each participant in a pilot scheme brought to an end as a result of a direction under subsection (3) to provide Part II services from the premises from which he was participating in the pilot scheme.'.

Government amendments Nos. 132, 137 and 139.

Mr. Denham: I should like to preface consideration of this group of amendments with some introductory remarks that will put them into context. In this group, we are proposing two new clauses and various amendments to clauses 20 to 29. Together, they will substantially update the provisions for managing primary care practitioner lists. The health authority lists of practitioners underpin health authority systems for managing primary care services and for assuring quality.
The clauses will modernise the system by giving health authorities powers to suspend or remove practitioners from their lists; by extending those arrangements into the new service delivery arrangements, such as personal medical services, under part I of the National Health Service Act 1977; by giving health authorities powers to remove practitioners from their lists on grounds of their unsuitability, as well as in the interests of the efficiency of the service or because of fraud; and by giving practitioners rights of appeal to the Family Health Services Appeal Authority against decisions by their health authority to remove them from its list.
At the same time, we are reconstituting the appeals authority, so that it will be fully independent of the Secretary of State, and including provisions to ensure that the new system operates quickly to address any risks to patients or to the service and effectively to deliver outcomes that are proportionate and fair to practitioners.
The legislation is, however, only part of the new arrangements that we are putting in place. We are developing primary care trusts and clinical governance arrangements. In the next year, beginning in April 2001, we are introducing appraisal for all general practitioners. We are also introducing the new National Clinical Assessment Authority.
We think that only a very small number of practitioners are likely to be removed or suspended under the new arrangements. Suspension or removal may not be the best response. In the first instance, support through clinical governance or reference to the NCAA may be the appropriate response. We need to know, however, that we have effective powers in place if they are necessary.
This group of amendments includes Government new clauses 11 and 12. Although I accept that there seems to be a long list of amendments in this group, they are designed to give effect to the proposals which I explained in Committee and which I have just outlined. They are

intended to refine the provisions, to deliver a consistent approach for all the primary care practitioner professions and to achieve the best balance between safeguarding patients and the rights of the practitioner.
There are so many amendments because the legislation is complex and necessarily deals with each practitioner group separately. There are four separate groups—doctors, dentists, pharmacists and optometrists—and one hybrid group composed of dispensing doctors. Four of those groups—doctors, dentists pharmacists and dispensing doctors—may now operate under part I or part II of the 1977 Act. Consequently, it may be necessary to replicate a simple to technical amendment several times. New clause 11, for example, is accompanied by 17 consequential amendments.
I propose to concentrate in my opening remarks on the more substantive amendments, beginning with new clause 11 and its consequential amendments. Current legislation does not allow a health authority to have access to the criminal record of a doctor working in general practice. In requiring a doctor to declare his criminal convictions when he applies to join a health authority list, it is our intention that the health authority should take action to verify the information that it is given. To do that, we have to rely on the Home Office's new Criminal Records Bureau, which was established in part V of the Police Act 1997, to provide criminal records checks for employers.

5 pm

Mr. Michael Fabricant: Will the Minister give way?

Mr. Denham: I would like to make a little progress, if I may.
Our policy, supported by those responsible for setting up the Criminal Records Bureau, has been that the health authority should have the fullest possible report from the CRB to ensure maximum protection for the public. The Bill currently provides that health authorities will be able to obtain from the planned Criminal Records Bureau certificates issued under sections 112 and 113 of the 1997 Act to confirm the completeness of any declarations made by a doctor about criminal convictions.
New clause 11 would also enable health authorities to obtain section 115 certificates. These are enhanced criminal records certificates which provide valuable additional information to health authorities, albeit in a small number of case s. They might well help to keep an unsuitable practitioner off the health authority lists and out of primary care. As such, we do not think we should lose the opportunity to improve the level of protection available to patients.

Mr. Philip Hammond: Will the Minister give way?

Mr. Denham: I shall give way first to the Opposition Front-Bench spokesman on the ground of seniority and then to the hon. Member for Lichfield (Mr. Fabricant).

Mr. Hammond: I do not wish to get in front of my hon. Friend in the queue. By what process did the Government originally conclude that the standard certificates were adequate and subsequently conclude that


an enhanced certificate would be appropriate? Could not the Government have reached that conclusion in Committee?

Mr. Denham: That is a somewhat metaphysical question. The consultation document issued last summer indicated the need for the broader range of scrutiny through the Criminal Records Bureau. We are ensuring that legislation reflects that policy intent.

Mr. Fabricant: I am grateful to the Minister for giving way to me, finally. Is he aware that the Criminal Records Bureau will be using the police national computer to access the information as to whether someone working in the health service has a criminal record? Is he aware that the Home Office admits that up to 65 per cent. of the records of the Phoenix database—the system used on the police national computer—are either out of date or wholly inaccurate? How will the Minister ensure that a doctor, nurse or someone else in a position of responsibility will not be accused of having a criminal record when they do not have one? More worryingly, w hat provision has he made for those who do have a criminal record that does not show up in the CRB investigation? Also, what fee will be charged for the CRB inquiry? Will it be at enhanced or standard level?

Mr. Denham: Issues of accuracy are important, but they are for Home Office Ministers. We will work closely with the Home Office and we will need to follow Home Office guidance on the use of the Criminal Records Bureau. A code of practice has been set out by the CRB on the handling of data and information. I assure the House that we will work closely with the Home Office on the issue. Clearly, we wish to avoid circumstances where people are unfairly accused of crimes or are reported for complaints in relation to which they are not guilty.
I understand that a Home Office decision on the fee is imminent, but there has been no announcement as such. I do not know what the fee will be. Clearly, we will need to discuss this with the professions. The system of remunerating professions varies; there are variations in the systems for paying expenses and so on. The liability for various expenses varies from profession to profession; that is something we will need to discuss with them.

Mr. Fabricant: The Minister will be aware that there are provisions for the transmission of what the Home Office calls soft data. That is not covered in new clauses 11 or 12. What is the reason for that omission?

Mr. Denham: I should have to refer back to the drafting to clarify that point, but I can tell the hon. Gentleman that the new clauses do include what is called section 115 data—the soft intelligence to which he referred. I do not have the text of the new clauses to hand and so cannot point to the exact line as the hon. Gentleman might wish me to, but I assure him that the point is covered by the proposed amendments. Perhaps he was trying that question on, but 1 assure him that I understand what the new clauses are intended to achieve.
I shall deal now with new clause 12 and amendments Nos. 69, 70, 108, 109, 112 and 11 Clause 27 already introduces proposed new section 4913 to the 1977 Act to allow a health authority in fraud and efficiency cases contingently to remove a person from its lists. The effect

is that a person's continued presence on the list may be subject to specified conditions. If those conditions are broken, the person may then be removed from the list.
That provides a half-way house: a person is given the opportunity to provide family health services but under sensible conditions imposed by the health authority to protect the interests of patients and the NHS. Clearly, if it is possible for there to be contingent removal from a list, it is reasonable to be able to impose conditions when a person applies to join one of the lists. New clause 12 therefore provides for a health authority to have conditional inclusion in a list to match the possibility of conditional removal.

Dr. Peter Brand: It is clearly important to have the maximum patient protection regulations, but I am worried by what the Minister said about such regulations being in the interests of the NHS. I am also concerned that new clause 12 uses the word "efficiency" but does not define it. If the word "efficiency" is not used to mean the interests of patient care, will the Minister help the House by defining it?

Mr. Denham: The term "efficiency" is not defined in primary legislation, to the best of my knowledge, but it has been used in such legislation for a very long time. It is one of the grounds on which the NHS tribunal is able to remove a practitioner from the NHS. We have sought to include the test of suitability in the new clause, but the amendments as a whole provide a consistent set of criteria needed to meet the tests set by the Bill. The use of the word "efficiency" in new clause 12 merely mirrors a usage that has appeared in legislation since the establishment of the NHS tribunal.
Amendments Nos. 69, 70, 108, 109, 112 and 113 make similar changes to those outlined in respect of the services lists. The remaining amendments in the group cover technical matters. If hon. Members want to go through them in more detail, I should be happy to do so.

Mr. John Bercow: The Minister will not be surprised if I return to my normal, and I think justifiable, hobby horse—the means by which regulations will be approved. Will the Minister confirm that, as usual, the Government intend that the regulations will be subject to the negative resolution procedure—that is, that no debate on the regulations and their detail will be permitted?

Mr. Denham: Normally, instruments subject to the negative resolution procedure may be prayed against, in which case there will be debate in Committee. Some of the most important and sensitive regulations in what used to be clause 59 and is now clause 62, which deals with patient information, will be subject to the affirmative resolution procedure. That has been the case since the Bill was first drafted, and it is a mark of the importance that the House and people outside it attach to those provisions.

Mr. Hammond: Before I start my speech, I draw the House's attention to my registered interests. They are not directly relevant to the subjects under discussion, but I have declared them at every stage of the proceedings on the Bill.
Amendment No. 31 deals with clause 34, which introduces local pharmaceutical services, or LPS, pilot schemes and provides for a relevant authority—the


Secretary of State in England or the National Assembly in Wales—to end a pilot scheme in certain circumstances. The schemes proposed will probably involve providers of part II services who are in place prior to the pilot scheme and, possibly, new entrants, to expand the provision of services in areas where the relevant authority feels that it is not adequate.
To take part in the schemes, new entrants will have to expend capital, principally in establishing a place of business. In Committee and, indeed, before that, Ministers told us that there will effectively be a two-way ticket for pilot schemes in personal medical services and personal dental services. If a scheme ends, the practitioner will be able to return to providing general medical services or general dental services under the former arrangements. Ministers also indicated in Committee that when LPS pilot schemes end, they intend that those involved in providing services through those schemes should have the opportunity to continue to provide pharmaceutical services under part II of the 1977 Act. The amendment would insert into the Bill the assurance that Ministers have given.
That assurance is important because if the pilots are essentially to be terminable at the whim of a politician, it is difficult to see how private sector businesses will be encouraged to invest their capital in setting up premises and delivering the services that Ministers want to be provided under those pilots. It is important that people who are contemplating investing in projects to make the pilots work know that if the scheme is terminated at the Secretary of State's whim, they will still be able to continue to provide pharmaceutical services from those premises and that their investment will be protected. That guarantee is essential to ensure full uptake of opportunities under the pilot schemes, which we support. I urge the Minister to consider including that in the Bill to send a reassuring signal, as I am sure he wants to do, to private businesses whose investment he will be seeking to encourage.
Amendment No. 32 deals with clause 28, which concerns arrangements for personal medical services and personal dental services lists. It is right and proper to include in lists those who are providing those services, which are in addition to the range of primary care services provided. There are indications that the Government are pressuring practitioners to move to PMS and PDS as the preferred modes of delivery. It would be strange if it appeared that providers of those services were being penalised in comparison with providers of general medical, dental, ophthalmic and pharmaceutical services.
Clause 27, which deals with general services, contains a specific requirement for the Secretary of State to consult with organisations that represent people providing those services. There is no similar provision requiring the Secretary of State to consult with people representing providers of personal medical services and personal dental services.

In Committee, the Government sought to justify the exclusion of any consultation with the representatives of PMS and PDS on the ground that such services were governed by a different, locally negotiated contract. However, the representative bodies concerned—largely the same as those representing providers of general medical services and general dental services—do not entirely agree with the Minister. The introduction of the national core contract in PMS somewhat undermines the Minister's argument that these contracts are wholly different, locally negotiated and not amenable to national level discussions with representative bodies.
Under clause 27, the Government are proposing to consult with the representative bodies. We think that it is proper and appropriate to include in the Bill a requirement to consult with bodies representing PMS and PDS providers before making any regulations under clause 28. It is not obvious from any debate that has been held so far what objection the Government have to such a provision, especially since, in practical terms, the Government would almost certainly discuss any such regulations with the very same body with which they were discussing clause 27 regulations.
There are 74 Government amendments and two Government new clauses in this group. I am tempted to say that that must be a record, but my time in the House has taught me that that is a dangerous statement to make—and there are Finance Bills to be taken into account. It is none the less a very large group of amendments.
The Minister has told us that these are technical amendments. I have teen through them in some detail and I concede that that is right. For the most part, they are technical and, to some extent, repetitious. It is not the substance of the amendments that concerns me but the Government's need to table this vast number of amendments very late on Monday night. I thought that I was cutting it fine tabling the Opposition amendments at 10.5 pm, during the Division. However, I have since discovered that all he Government amendments were tabled after mine, cutting it very fine indeed.
What that tells us is that when we have rushed legislation, a very short gap between Second Reading and Committee and another very short gap—two or three sitting days—betweel Committee and Report, there is a danger that the drafting of the legislation will be found wanting. Clearly, the Government have found the drafting of the legislation wanting, and so have tabled a vast raft of amendments and new clauses in an attempt to address some of those defects. It would be stretching credulity to imagine that in the frenetic rush between Thursday. when the Committee concluded its proceedings, and 10.15 pm on Monday, when the Government finally tabled their amendments, they had exhaustively examined every aspect of the Bill and discovered every defect, given that the 100-odd defects were not discovered prior to the Bill's consideration in Committee. It is reasonable to assume that more defects will emerge in due course.
It would be useful to reflect on one of the reasons why we traditionally leave gaps between the different stages of our proceedings in legislation. It is not so that we can diligently spend our evenings reading the small print of Bills, but so that bodies outside may have an opportunity


to reflect on what the Government propose and suggest to them ways in which the Bill might be improved or tightened up.

Mr. Bercow: Does my hon. Friend agree that, in relation to this group of amendments, the Government must be convicted on one of two charges? Either the Minister of State knew perfectly well at, or shortly after, the conclusion of Committee on Thursday night what the content of the new amendments was to be—in which —case it was, at the least, a gross discourtesy not to table them earlier and to give Members and outside organisations an opportunity to study them—or, alternatively, the right hon. Gentleman did not know until some time after 10 pm on Monday what the content was to be—which, if true, is even more disturbing.

Mr. Hammond: My hon. Friend is right. The latter prospect alarms me most; it suggests that rafts of further amendments will be tabled in the other place which we shall have an extremely limited opportunity to scrutinise in this place.
To take up my hon. Friend's fist proposition, I was quite surprised to hear the Minister's comments on new clause 11. If I heard the right hon. Gentleman correctly, he suggested that the need for an enhanced criminal record certificate was identified during the consultation procedure last summer. If that is so, I am sure that my hon. Friend will agree that it begs the question—why did the Government not table the amendment during Committee? Indeed, why did they not draft the original Bill so that it reflected the requirement for an enhanced criminal record certificate? I intervened to ask the Minister whether he could throw any light on the matter, but I am none the wiser.

Mr. Bercow: The situation becomes curiouser and curiouser. As you know, Madam Deputy Speaker, I am a kindly chap and always charitable towards Ministers; far be it from me ever to cast aspersions on the competence—still less on the mindset—of Ministers. However, in the circumstances that my hon. Friend has just pithily described, is he not concerned 'hat the Minister is becoming almost as unfocused as tile right hon. Member for Hartlepool (Mr. Mandelson)?

Mr. Hammond: I suspect, Madam Deputy Speaker, that you would not want me to pursue the line of argument towards which my hon. Friend tempts me. I am sure that the Minister has heard my hon. Friend's comments and that he will reflect on his own state of mind in his private moments.
If the Government are telling us that an enhanced criminal record certificate is a vital part of the procedure—the mechanism outlined in the measure—new clause 11 is, of course, essential to life Bill's architecture and we have no argument with the substance of the provision. However, the Minister owes the House an explanation as to why, when the requirement appears to be central to the working of the Bill, the Government failed to identify it at an earlier stage; the provision is not about a missing comma—it is a major requirement that amends another piece of legislation. Had the Government failed to recognise the problem one amend this Bill, an absurd situation would have arisen practitioners would

have been required to obtain a certificate under the Bill that they were not empowered to do under another piece of legislation—the Police Act 1997.
Either the Minister must explain why the Government have only so recently identified that error in their thinking, or—to refer to the right hon. Gentleman's earlier remarks—he must explain why the Government neither included the requirement in the original Bill nor tabled it as an amendment in the Standing Committee. Bluntly, the Government ought to tell the House whether they became aware of that shortcoming only after the conclusion of the proceedings of the Standing Committee. I look forward to hearing from the Minister in due course.
Government new clause 12 provides for conditional inclusion in lists, with an adequate right of appeal against the conditions. Once again, we have no argument with the principle of the proposal. When I first read the new clause, I wondered why it applied only to providers of general medical, dental and ophthalmic services and so on. I initially concluded that the explanation was that the Bill will already write into the National Health Service Act 1977 proposed new sections 43D(3)(d) and 28DA(3)(d), which will, in effect, provide for conditional inclusion in lists. However, 1 continued to read the amendment paper and discovered that the Government will amend those provisions under Government amendments Nos. 69, 108, 112 and 113. I can only describe that as a mess.
It appears that the Government initially forgot to include part II services in the arrangements for conditional inclusion and now want to correct that under new clause 12, but they then realised that the arrangements that they had included on the conditional inclusion on lists of PMS and PDS providers were faulty and needed to be corrected, which they will do under Government amendments Nos. 69, 108, 109, 112 and 113. Perhaps the Minister will explain exactly what happened.
Perhaps the Minister will also explain why Government amendments Nos. 69, 108 and 109, under which the arrangements on conditional inclusion in lists for PMS and PDS providers will be amended, and Government amendments Nos. 112 and 113, under which the supplementary list will be similarly amended, do not use words similar to those in new clause 12. Why does the right hon. Gentleman still propose for PMS and PDS providers and for the supplementary lists a different regime from those that proposed in new clause 12?
In particular, the two provisions diverge on what I shall call a motive test. Under new clause 12, proposed new section 43ZA(2) will provide such a test. It states:
The imposition of conditions must be with a view to—
preventing any prejudice to the efficiency of the services…or preventing any acts or omissions within section 43F…
No such motive test has been included in proposed new sections 43D and 28DA of the 1977 Act. I should be grateful to the Minister if he would explain that apparent inconsistency.
Government amendments Nos. 40 to 109, which could give the House serious indigestion, are largely technical, but I want to make one or two other points on them. Of course, it is disappointing that the Government have had to table them on Report. On Government amendment No. 59, will the Minister tell us why it has been necessary to replace the term "director of" with the phrase
member of the body of persons controlling"?


A perfectly good definition of the word "director" exists in company law, which deals precisely with people who exercise the functions of a director and are part of the body controlling a company but may not be called a director. Why have the Government found that amendment necessary? Does that presage a wider amendment of company law to change the definition of the word "director"?
I should like the Minister to tell us about amendment No. 75. First, it will introduce a wholly new concept in legislative drafting. Perhaps I have merely missed the concept previously. It refers to "this group of sections". I have seen references to a section, a subsection, a part or, indeed, a whole Bill, but I have not seen a reference to a group of sections. Incidentally, that reference reappears in Government amendment No. 105. Will the Minister tell us where the group of sections is defined? Which sections belong to the group and which do not?
5.30 pm
At a substantive level, amendment No. 75 will create a situation in which, for example, the whole business of a chain of retail pharmacists could be placed in jeopardy by the actions or omissions of a director which may have taken place not during his service as a director but formerly. Perhaps he has failed to divulge information to his current employers. I am charitable enough to imagine that it is the Government's intention that the power in the amendment will in fact be used to impose a condition requiring that person to stand down or to cease to have control over, or a hand in, the running of the business. That would be entirely understandable, reasonable and fair. If the Minister could make that explicit when he winds up this short debate, we would feel much more comfortable.
Unless I missed it amid the routine of dealing with the other amendments, the Minister failed to acknowledge the small part that the Opposition played in amendments Nos. 84 and 85. We achieved a small victory in Committee by extending the period allowed to practitioners for appeal from 21 days to 28 days, bringing it into line with the appeal deadlines for General Medical Council hearings. We are grateful to the Minister for tabling the amendment, but not for his failing to acknowledge its provenance.
I have one other concern. Amendments Nos. 96 and 99 make changes to the use of the words "practitioner" and "person". They change the word "practitioner" to "person" in a number of places in new section 49K. Superficially, that is an attractive change. A practitioner is a practitioner if he practises, and if he is prevented from practising it is arguable that he ceases to be a practitioner, while remaining a person. However, the word "practitioner" remains in new section 49K(1) at lines 5 and 12 on page 28 of the Bill. Amendments Nos. 101 and 102 also change the references from "practitioner" to "person" in relation to the appeal procedure in new section 49K(4)—at line 32 on page 28, for those who follow such matters avidly. Amendment No. 102, which extends the same subsection, also uses the word "person". The wording appears to me and to my hon. Friends to be inconsistent, but that is possibly the result of shoddy drafting. We have ended up with a single subsection that refers both to "practitioner" and to "person".
This large group of amendments amply demonstrates the dangers of rushed legislation. It represents a warning to Ministers of the pitfalls of rushed legislation in general and of this Bill in particular. I am sure that the Minister cannot be happy that his officials, having trawled through the Bill, have found in the space of a week about 100 matters that need correction. He will be as alarmed as I am at the prospect that there will be hundreds more to come before the Bill sees the light of day in another place.
I concede that no issues of great significance are at stake in the substance of the amendments, but I should like to hear the Minister's answers to our specific questions about the Government amendments and new clauses, and to hear something of the story that lies behind the extensive and radical group of amendments that has become necessary.

Mr. Fabricant: You will be relieved to know, Madam Deputy Speaker, that 1 shall not consider the 100 or so amendments in the group, but speak to new clauses 11 and 12.
Although I welcome the measure in principle, I wonder whether it will work in practice, at least over the next few years. It just so happens that the Select Committee on Home Affairs, on which I have the hour to sit, is investigating the procedures by which the Criminal Records Bureau will be established. We met the Minister of State, Home Office, the hon. Member for Norwich, South (Mr. Clarke), two days ago, and the Director General of the Data Protection Agency yesterday, and learned some alarming facts, which imply that joined-up government is non-existent in this respect.
No accurate prediction has been made of the demand that might be placed on the CRB. That creates two problems. First, we do not know precisely how large the computer capacity will have to be, how many terminals will be needed and how many people will have to be available to answer the inquiries. Secondly, it is difficult to assign a cost to the service. That is of particular interest to people who, like me, live in cities where health services are declining. The hospital in Lichfield is under threat, as are the services that it provides. According to the local health authority, that is because there is not enough money.
When I asked the Minister how much it would cost the health service to make inquiries about those two matters, he could not answer. I do not blame him for that—he was right to say that he did not know because the Home Office had not yet decided what the scale of fees should be. That corresponded with the evidence that the Home Office Minister gave to the Home Affairs Committee two days ago—so there is a little bit of joined—up government. He was asked when he would be able to estimate when the fee scales would be available, but he could not say. That creates a budgeting difficulty for the national health service at a time when services in Lichfield—I know that you, Madam Deputy Speaker, are familiar with Lichfield—and other parts of the United Kingdom are under threat.
An additional difficulty concerns the accuracy of information held or the Phoenix database, which is maintained by the police national computer and to which the CRB will have access. About 65 per cent. of its records are inaccurate. Either people are detailed as having committed a crime when they have not or—
equally worrying—people are not listed as having committed a crime when they have been convicted. The Home Office is working closely with the Association of Chief Police Officers, local magistrates courts and the judicial system in general to try to ensure that the records are kept up to date or made more accurate. However, when I asked the Home Office Minister when the Phoenix database would be accurate enough to be of use to the NHS and organisations such as the scouts and the Guides that will have to make use of it, he could not say.
We have a negative double whanimy—if there is such a thing. The Bill has been brought hastily before the House and we have only three or 'bur hours to discuss huge tranches of amendments. New clause 11 has an interface with section 115 of the Police Act 1997. They relate to the ability to access the CRB, but that will not have accurate information for some lime. We do not know how much time; it seems that the Home Office Minister and the police are unable to say.
I asked the Minister earlier about provision for the national health service and others concerned with the new clause to access soft data. After a short pause, he said that the matter was covered by section 115 of the Police Act 1997. I am not sure that it is. I fully accept that the right hon. Gentleman is not a Home Office Minister. However, I ask him to consider the matter in more detail, with the necessary reference. I remind him mat soft data, as they are known, are tremendously important, as they concern police intelligence.
Hamilton, who committed the massacre at Dunblane, had no criminal record. The enhanced criminal record certificate, even if it were up to date, would say that he would be all right to operate as me of the types of practitioner listed in detail in suggested new subsection (6C)(a) to (d) and so forth.
Intelligence information given by the local police force to the Scouts stopped the scouts from recruiting Hamilton as a Scout leader. That intelligence is known as soft data. I am not sure that there are mechanisms in new clauses 11 and 12 that would give the national health service access to such data.
On a day when newspapers are, rightly or wrongly, full of condemnation of the sentences that have been handed down by judges to known and convicted paedophiles, it is prescient to remind ourselves that now, much of the information on paedophiles is, before conviction, available only as soft data. The new clause is a worthy provision, but surely the Government would wish it to identify paedophiles and others who might not yet have a criminal conviction. That can be done only through the acquisition of soft data. As I have said, in the absence of a conviction, the enhanced criminal record certificate would produce a negative. The Minister ha: a duty to the House to ensure that we are satisfied that such soft data are made available.
I shall ask some specific questions. They may be slightly unfair because perhaps they apply more to the Home Office than to the Department of Health, but this is a Department of Health Bill. When does the Minister expect that the information held by the Criminal Records Bureau will be sufficiently accurate to be of real practical use to the NHS? When will the right hon. Gentleman next meet the Minister of State, Home Office to press for the information to be made available to him—assuming that it is accurate? When will he be able to say to the House

with assurance, "This is how much the provision will cost the NHS"? What estimate has he made of the number of inquiries that the NHS will make to the Criminal Records Bureau under new clauses 11 and 12 in the next three or four years? When will he ascertain from the Home Office precisely what the charges will be for each such inquiry?

Mr. Denham: I shall reply as briefly as possible. The hon. Member for Runnymede and Weybridge (Mr. Hammond) deserves due credit for the extension from 21 days to 28. I apologise to him for omitting to say that in my earlier remarks. I am pleased that there is no argument in the House with the principle behind new clauses 11 and 12, and I am sure that means that we will be able to agree on those matters.
5.45 pm
To touch briefly on the main questions raised by the hon. Member for Runnymede and Weybridge, new clause 12 introduces conditional inclusion for part II services. Consequential amendments provide for conditional inclusion in supplementary lists, personal medical services lists and service lists. The hon. Gentleman is simply wrong in his interpretation that the Bill originally provided for conditional inclusion in PMS lists. The new clause and the amendments are therefore necessary.

Mr. Hammond: Will the Minister therefore tell me why, under clause 26, proposed section 43D(3)(d) states that regulations may, in particular, include provision on
requirements with which a person included in a supplementary list must comply"?
To me, that is a conditional inclusion.

Mr. Denham: I may be able to find the time to give an extended reply in due course. However, my initial response is that that covers matters such as the fact that someone should be suitably qualified to be a GP, rather than conditional inclusion in a list. It is desirable that the Bill should be clear, and that there be a specific power covering conditional inclusion in a list, rather than have such inclusion implied, as the hon. Gentleman suggests, in other parts of the Bill.
Amendment No. 59 would change the word "director" to the words "member of the body of persons controlling". The hon. Member for Runnymede and Weybridge said that there was a perfectly satisfactory definition of a director in company law. However, there is a new arrangement: limited liability partnerships do not have directors as such, so to cover them, the Bill needs to include a separate identifier of persons in control. Those partnerships may well be suitable for some providers of health services—in pharmacy, for example.
The hon. Gentleman asked about "this group of sections" which is defined in proposed section 49F(5) in clause 27, and runs from proposed sections 49F to 490. There is an apparent inconsistency between the terms "practitioner" and "person", but in context they are right. The word "practitioner" is used when it refers to a specific practitioner, such as a member of a medical list. The word "person" is used in the legal sense, and was used in the drafting to deal with a list that could include a corporate body, such as a dental list or a pharmaceutical list. There is a reason behind the apparent inconsistency: in fact, it is not an inconsistency.
The hon. Member for Lichfield (Mr. Fabricant) asked about enhanced criminal records and soft information. Sections 115(6) and 115(7) of the Police Act 1997 are the relevant provisions which cover the information that he and I wish to see. Most of the other questions that he asked were touched on earlier or—I must, with respect, point out—are matters for my colleagues in the Home Office.
The hon. Member for Runnymede and Weybridge tabled two amendments, with which I must deal. The first relates to local pharmaceutical pilot schemes. The hon. Gentleman is right about the issue, but wrong about the remedy. Amendment No. 31 would mean that if the relevant authority gave directions to terminate a pilot scheme because it was unsatisfactory, it would also have to direct the health authority concerned to make arrangements with all the participants under the national arrangements for pharmaceutical services instead. I accept that if we are to attract volunteers to local pharmaceutical services pilot schemes, especially if they involve the investment of a significant amount of new capital by the provider, we will have to have arrangements for what happens when pilot schemes come to an end.
Clause 39 provides powers to make regulations on the inclusion and reinclusion of premises in pharmaceutical lists. Our intention is that before people start providing LPS, they will be told whether and to what extent they will have a preferential right of return—or, in the case of new providers, transfer—to the national arrangements.
We will consult before we decide the precise criteria for preferential rights, but without prejudging the results of that consultation, I can say that there may well be rights of transfer even when the Secretary of State has to terminate a scheme by direction because it is unsatisfactory. However, that does not mean that we should go as far as the absolute right that would be conferred by the amendment. For example, I do not see why, if the Secretary of State were forced to close a scheme because the service provided had fallen below acceptable standards, the provider should have the right to continue providing the service under part II arrangements.
It would be much better to have the flexibility to tailor the arrangements made in particular cases or types of case to the needs of the health authority and the LPS provider. None of us would want an absolute right to be used as a way of getting round the established rules of entry. That is the main difficulty with the amendment.

Mr. Hammond: We are not disagreeing on an issue of principle, merely on the mechanics. The Minister said that he would rather rely on the discretionary power to deal with such a situation as it arose, but is not the problem that in order to attract capital investment into under-provided areas, there will have to be a right up-front? Unfortunately, that may mean that rights are given in advance to a provider who subsequently turns out to be the reason why the pilot fails. If the Minister cannot give the necessary guarantees up-front, surely he will not attract the investment that he seeks.

Mr. Denham: I agree that people will not come forward with money unless they believe the investment to be reasonable. However, the way to deal with the problem is not by writing an absolute right into the Bill. It would be best dealt with case by case, scheme by scheme—otherwise, we will be issuing an open invitation to exploit the situation, not because people want to provide pharmaceutical services in an innovative way, but because that seems like a way round the normal restrictions on rights of entry.
Finally, amendment No. 32 would require the Secretary of State to consult appropriate organisations of PMS or PDS practitioners be fore making regulations about the lists. We intend to mirror in those lists the conditions that apply to GMS or (IDS lists. However, as I said in Committee, we do not believe that we should put into the Bill formal negotiating rights in respect of personal medical services, for example.
PMS pilots are voluntary contractual arrangements entered into at local level. The existence of a core contract does not alter the fact that the arrangement is voluntary. Although we discuss arrangements for PMS with representatives of the British Medical Association and a great many other organisations, both informally and through the PMS implementation group, we do not believe that writing formal legal negotiating rights into the Bill is the right way forward.
Of course, GPs entering PMS have every right to be represented locally by the local medical committee. No one is saying that they should not be represented in negotiations at local level, but there is a difference between that and extending formal legal negotiating rights over PMS through the Bill, as the hon. Gentleman seeks to do.

Mr. Hammond: The right hon. Gentleman is saying that because PMS is a voluntary scheme, people who enter it should not haw statutory negotiating rights. In Committee, the Minister could not rule out the possibility that PMS would cease to be a voluntary scheme, with single-handed practitioners, in particular, being forced into it at some stage. Can he give an undertaking now that if PMS ceases to be a purely voluntary scheme, he will take measures to gig e statutory rights of consultation to those who are to be included other than voluntarily?

Mr. Denham: Clear1y, we would have to examine the position if the contract were national rather than local. As the hon. Gentleman knows, our approach with regard to single-handed practitioners is through agreed changes to the national contract. We shall discuss that with the general practitioners committee of the BMA in the months to come. The concerns that have been expressed about single-handed practices can be addressed through appropriate changes to the national contract. That is our preferred way forward.
I hope that I have dealt, albeit briefly, with the substantive issues raised in the debate.

Question put and agreed to.

Clause read a Sec9nd time, and added to the Bill.

New Clause 12

CONDITIONAL INCLUSION IN MEDICAL, DENTAL, OPHTHALMIC AND PHARMACEUTICAL LISTS.

?.After section 43 of the 1977 Act them shall be inserted

"Conditional inclusion in medical, dental, ophthalmic and pharmaceutical lists

43ZA.—(1) The Secretary of State may by regulations provide—

(a) that if a person is to be included in a list referred to in subsection (3), he is to be subject, while he remains included in the list, to conditions determined by the Health Authority,
(b) for the Health Authority to vary that person's terms of service for the purpose of or in connection with the imposition of any such Conditions,
(c) for the Health Authority to vary the conditions or impose different ones,
(d) for the consequences of foiling to comply with a condition (including removal from the list), and
(e) for the review by the Health Authority of any decision made by virtue of the regulations.

(2) The imposition of conditions must be with a view to—

(a) preventing any prejudice to the efficiency of the services in question, or

(b) preventing any acts or omissions within section 49F(3)(a) below.

(3) The lists in question are—

(a) a list of persons undertaking to provide general medical services,
(b) a list of persons undertaking to provide general dental services,
(c) a list of persons undertaking to provide general ophthalmic services,
(d) a list of persons undertaking to provide pharmaceutical services.

(4) If regulations do so provide, they must also provide for an appeal by the person in question to the FHSAA against the Health Authority's decision—

(a) to impose conditions, or any particular condition,
(b) to vary a condition,
(c) to vary his terms of service,
(d) to remove him from the list for breach of condition, and the appeal shall be by way of redetermination of the Health Authority's decision.

(5) The regulations may provide for any such decision not to have effect until the determination by the FHSAA of any appeal against it.".'.—[Mr. Denham.]

Brought up, read the First and Second time, and added to the Bill.

New Clause 13

APPLICATION TO THE CITY OF LONDON

?.—(1) The Common Council may establish a committee which has, in relation to the City of London, the powers which under section 021(2)(f) of the Local Government Act 2000 a local authority's overview and scrutiny committee has in relation to the authority's area.

(2) Sections 7(3) to (6), 8 and 9 and Schedule I apply as if such a committee were an overview and scrutiny committee and as if the Common Council were a London borough council.

(3) Section 21 of the Local Government Act 2000 applies as if such a committee were an overview and scrutiny committee and as if the Common Council were a local authority, but with the omission—

(a) of subsections (1) to (3), (5) and (9),
(b) in subsection (8), of "Executive",
(c) in subsection (11), of paragraph (b), and
(d) in subsection (13)(a), of the reference to members of the executive.

(4) In the provisions applied by subsections (2) and (3), references to functions under any provision of section 21(2) of the 2000 Act are, in the case of the committee established under subsection (1), references to its functions under that subsection.

(5) "The Common Council" means the Common Council of the City of London.'.—[Mr. Denham.]

Brought up, and read the First time.

Mr. Denham: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker: With this it will be convenient to discuss Government amendments Nos. 141 to 143, 140 and 155 to 158.

Mr. Denham: Amendments Nos. 140 to 143, although essentially technical, are vital for the scrutiny arrangements across London and for authorities that operate alternative arrangements under the terms of the Local Government Act 2000. Alternative arrangements will exist where overview and scrutiny committees are not in place.
First, the amendments make it possible for overview and scrutiny committees to join forces with the authorities that are operating alternative arrangements to OSCs under the Local Government Act 2000. Secondly, they give the common council of the City of London the power to establish a committee to scrutinise the NHS, giving the common council responsibility for scrutiny of the NHS in its boundaries. The committee will have powers and duties similar to the OSCs of other local authorities and it will be able to enter the joint arrangements provided for by clause 8.
We have been talking to the common council of the City of London and agreed that, although it is not covered by relevant provisions of the Local Government Act 2000, it should still be able to carry out the same scrutiny of the NHS as other social services authorities. Although the City might not be the most populated part of London, people do live there and important NHS services are provided there, notably at Bart's, which is within the City boundaries. The health services in the City of London need scrutinising, as do other health services.
The Greater London Assembly has made positive representations to the Government about its potential role in supporting the London boroughs in their new NHS scrutiny role. There are examples of NHS services, such as the London ambulance service, where the London boroughs may wish to work with the GLA and its structures to facilitate pan-London scrutiny. The Bill provides powers for the establishment of joint committees which would enable a pan-London committee to undertake scrutiny.
We will carefully consider the ideas coming from the GLA to make sure that it plays a positive role in Londonwide scrutiny of the NHS. The GLA raised a number of issues concerning independent advocacy,


to which I will return when we discuss the relevant amendments. We shall examine ways in which the GLA can be appropriately involved, working alongside the legal scrutiny powers provided by the Bill.
Amendments Nos. 155 to 158 are technical amendments to ensure that schedule 1 provisions on exempt information apply consistently to all primary care contractors.
I commend the new clause and the amendments to the House.

6 pm

Mr. Desmond Swayne: Although we are considering one Government new clause and 12 Government amendments, I feel that the House and the nation are awaiting our debates with anticipation. Given the timetable motion to which we are subject, I shall not dwell for too long—

Mr. Bercow: Oh!

Mr. Fabricant: Shame

Mr. Swayne: I can only say that I share my hon. Friends' concern—"Oh!" indeed. Let me borrow a phrase from new Labour and political correctness, and say that I share their pain. If I am not mistaken, they will be unfamiliar with clause 8, to which four of the Government amendments apply. That would not be the case if they had been swatting up in the Library last night, but the record will show that they were, as always, in their places, holding the Government to account and giving their business proper scrutiny.
My hon. Friends will not have seen clause 8 before because it was not in the Bill on Second Reading. It was introduced on Thursday last week, at the end of the Committee stage. Three parliamentary days later-I am not sure whether we should count Friday as a full parliamentary day

Maria Eagle: Some of us were here.

Mr. Swayne: I was here on Friday, but as there was no quorum and not even 40 out of the 659 Members of Parliament were present to secure the passage of a private Member's Bill, I am not sure whether it counted as a parliamentary day. Nevertheless, we are considering a significant number of amendments to a clause that was added to the Bill only in the final sitting of Standing Committee. If I were uncharitable, I might be inclined to say that that was owing to hasty and careless drafting on the hoof and that my noble Friends in the other place will doubtless take account of it. I am charitable, however, and I had been assured that, as one of the consequences of the new timetable motion regime, a new culture would descend not only on this place, but on the Departments—in this instance, the Department of Health. I had the impression that a Department would realise that it was no longer acceptable to table a raft of amendments at the last minute, because the timetable would not accommodate them. I am still looking forward to the arrival of that new

culture. We have been promised it, but it has unfortunately not yet been delivered, even though we still have to live with the limitations of the timetable motion.

Mr. Bercow: My hon. Friend has shocked me and, I suspect, my hon. Friend the Member for Lichfield (Mr. Fabricant). He is certainly describing a rum set of affairs, but can he diminish my pain and minimise the constitutional outrage that has been perpetrated by at least assuring me that the Government gave some advance notice of their intention to table the new clause at such a late stage?

Mr. Swayne: To be perfectly frank, I cannot remember whether they did so. I will say in the Minister's defence that he gave us notice of new clauses and amendments throughout the Committee stage; he was assiduous in warning us of their coming and providing details of them. However, there were so many that I lost count of which of his letters referred to which proposals, so I cannot specifically answer my hon. Friend's question.
I deal now with new clause 13, which tells us essentially that the Minister forgot the common council of the City of London, which is a rather significant thing to forget. I am sure that some of the Labour Back Benchers who appeared from time to time during discussion of the City of London (Ward Elections) Bill in the previous Session wish that he had not remembered it at all and were quite content for him to have forgotten it. Nevertheless, as it was forgotten, I should like to hazard a suggestion as to why that happened and how it might have been remembered. If we had not moved from Second Reading to Committee so swiftly—we did so at an indecent pace and with a severe shortage of elapsed time—the Department might have had time to think through the Bill rather more carefully. We would not then have been faced with the tabling of new clause 13 at the last moment on Monday night.
I do not want to detain the House, but I should like to ask two questions, the first of which concerns Government amendment No. 140. The Minister might tell me that I completely misunderstood the amendment when I wrestled with it at d with the Local Government Act 2000 in the Library last night. I accept that that is possible, but I seek clarification. The amendment refers to "subsection (2)". Is that provision contained in section 21 of the Local Government Act 2000 or in the Bill? I concluded that either might be the case, although the meanings that could be construed would be very different.
My second question relates to the exclusions contained in subsection (3) of new clause 13. Paragraph (a) of that subsection refers to the actions of the common council in respect of the omission
of subsections (1) to (3), (5) and (9)
of the appropriate section of the Local Government Act 2000. My principal concern relates to the exclusion of section 21(9) of that Act. Although I recognise that it would generally be unlikely for a member of the executive of a local authority to participate in the executive and scrutiny function of the health trust or authority, I can conceive of circumstances in which a local authority might want that to happen. Why is that exclusion made?
Similarly, subsection (3)(d) of new clause 13 excludes section 21(13)(a) of the 2000 Act. Again, I understand that the scrutiny function would not principally require


the involvement of members of the local authority executive, but I can envisage circumstances when such involvement might be desired. That might be especially likely in relation to aspects of the local authority's health policy that affect the proceedings or functions of the NHS trust that is under scrutiny.

Mr. Denham: The hon. Gentleman asked about the omission from the Bill of the common council of the City of London. I believe that I can say on reasonably sound ground that there is good precedent for such omission, but not for its being caught and put right in time. I seem to remember that Bromley was left out of the Health Authorities Act 1995, which was enacted under the previous Administration, and that it remained outside the remit of that Act for some four years That did not appear to affect Bromley health authority's operation, which was probably illegal for those four years.
I seem to remember also that the Isles of Scilly were left out of the National Health Service Act 1977 for 22 years, but I am not sure about that None the less, NHS services continued to be provided in the Isles of Scilly. I am glad that we are correcting the position on the common council.
I do not have a copy of the Local Government Act 2000 to hand, but I am reasonably sure that amendment No. 140 refers to section 21(2) of that measure. If I am wrong, I shall write to the hon. Member for New Forest, West (Mr. Swayne).
Without debating new clause 13(3) in detail, I believe that we should erect the right sort of Chinese walls between the various roles that people play, to avoid a conflict of interest in scrutiny. We have sought to do that in the new clause. I accept that it is always possible to debate whether the dividing line is in the right place, but we have tried to achieve that.
The new clause enables the common council to establish a scrutiny role for health. The common council does not have an executive in the context of the Local Government Act 2000 because it is excluded from it. The arrangements are therefore different.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 1

PATIENT DATA

?.—(1) The Secretary of State may by regulations make such provision for and in connection with requiring and regulating the transmission, holding, processing or otherwise dealing with prescribed patient information as he considers necessary or expedient for the purpose of maintaining disease registers.

(2) In this section—
disease registers" means those registers of incidence of specified diseases as the Secretary of State shall by regulation prescribe;
prescribed patient information" means patient information specified in or determined in accordance with regulations made by the Secretary of State under this section;
processing", in relation to information, means the use, disclosure or obtaining of the information or the doing of such other things in relation to it as may be prescribed by regulations.

(3) Regulations made under this section shall not be made unless a draft of the statutory instrument containing the regulation has been laid before, and approved by a resolution of, each House of Parliament.'.—[Dr. Fox.]

Brought up, and read the First time.

Dr. Liam Fox: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Mr. Michael Lord): With this it will be convenient to discuss the following amendments: No. 1, in page 58, line 17, leave out clause 62.

No. 33, in clause 62, page 58, line 18, at end insert "identifiable".

No. 34, in page 58, line 38, at end insert—
'(d) "identifiable patient information" in relation to subsection (1) means patient information in a form which allows the patient to be identified'.

No. 35, in page 58, line 38, at end insert—
'(e) regulations under subsection (1) may not prohibit or restrict the processing of patient information which is not identifiable patient information.'.

No. 15, in page 58, leave out from beginning of line 39 to end of line 26 on page 59 and insert—
'(3) The Secretary of State may by regulations make such provision for the collection, holding, processing, transmission and publication of patient information as he considers necessary for the purpose of maintaining disease registers.'.

No. 30, in page 60, line 3, at end insert—
'(8A) The Secretary of State shall establish an Expert Advisory Committee to advise him in connection with any regulations he proposes to make under this section, and shall consult the Expert Advisory Committee prior to making any regulations under this section.
(8B) The Secretary of State shall appoint a chairman of the Expert Advisory Committee established under subsection (8A) above who shall be empowered to appoint such persons as appear to him to represent relevant expert bodies to the committee.'.

Dr. Fox: The debate continues a discussion that we held in Committee. The question that we asked remains to be answered: do the Government aim to protect patients or the NHS and Ministers? Clause 59 in the original Bill is now clause 62, which allegedly clarifies matters but merely makes them murkier.
The Government claimed that new powers were needed to protect patients from abuse of the information that was held about them. They have not defined how such information could be used against patients or explained how the powers would affect its legitimate use, for example during drug trials. We tried to obtain clarification of the Government's arguments and assertions in Committee, but to no avail.
The Secretary of State's powers to divulge data at his discretion do not appear in the Government's national plan for the NHS. They have been included without consultation—surprise, surprise—as a method of restoring the attempted prohibition on the collection of anonymised data from retail pharmacists that the Court of Appeal rejected in December 1999. We debated that case at length in Committee. The Government claim that the Bill closes a legal loophole, without defining it. The court ruled that there was no loophole and the judge stated that
the law of confidence cannot be distorted
for the Department's purpose.
In the Committee's 12th sitting on 8 February, the Minister stated:
The clause does not outlaw independent reports on NHS services and it is not an attempt to restrict medical research. A fundamental point is that it does not signal any change to the Government's view about the importance of patient consent. That is a key point in today's debate. Informed consent is crucial to the Government's view of how a modern NHS should work. We cannot move to a patient-centred service if patients are not informed, consenting participants in the services they receive."— [Official Report, Standing Committee E, 8 February 2001; c. 477–78.]
However, the Minister failed to respond to the point that the clause grants the Secretary of State powers that future Secretaries of State could implement in a manner that is far more hard line than the Government's intentions as outlined by the Minister. His constant defence was, "We may have the powers, but we will not use them." That is unacceptable.
The Minister found it difficult to accept that the Bill's contents are what matters. Once a power is established, it can be used. We want greater clarification of the powers and when they can be used. New clause 1 seeks to achieve that.
British pharmaceutical companies could be at a severe disadvantage because of restrictions on research. Many expressed that concern to members of the Committee and other hon. Members. Access to anonymised data is essential to their work in developing new drugs and monitoring the safety and effectiveness of existing drugs. The restrictions would especially affect their fulfilment of regulatory obligations, including those that deal with adverse event monitoring and product withdrawals. In Committee, I quoted the words of one firm; they bear repeating tonight. NDC Health Information Services stated:
Commercial access to non-personal data provides considerable benefits to all concerned; the loss of this access will result in less efficient health care and less funding for medical research without any concomitant benefits to either government, health providers or patients.
If the Government continue to deny the effect of their decisions, it is incumbent on Ministers to explain why, not content with abolishing community health councils, they have introduced a clause that gives future Governments massive scope to prevent independent scrutiny of the NHS. It is part of a consistent approach by Ministers to running health care.
6.15 pm
Ministers must also explain contradictions. In a speech to patients groups in January, the Secretary of State said:
The days have gone when the NHS could act as a secret society. It cannot operate behind closed doors. It cannot operate in the dark. It has to take patients into its confidence.
Yet clause 62 allows him to disclose identifiable information to third parties without patients' consent and despite their objections. The Minister can introduce as many regulations as he likes, but the decision ultimately lies with the Secretary of State. He has the right to produce identifiable data, even when that is not in the patient's interest, if he believes that it is in the public interest or the wider health interest. That is unacceptable. Explaining the provision's operation in practice is not the same as defining it in the Bill. New clause 1 attempts to make the provision more explicit.
A letter to The Times on 1 February was signed by Sir Donald Irvine, president of the General Medical Council; Dr. Ian Bogle, chairman of the British Medical Council; Robert Boyd, chairman of the Council of Heads of United Kingdom Medical Schools; Denis Pereira Gray, the chairman of the Academy of Medical Royal Colleges; and James Johnson, chairman of the Joint Consultants Committee. They are top people, who are well respected and represent almost the whole spectrum of those who practice in medicine. The letter stated:
We agree with Alan Milburn that we cannot accept the benefits of medicine, science or research regardless of the wishes of patients or their relatives.
No one would have a problem with that. It continues:
However, Clause 59 of the Health and Social Care Bill threatens patient confidentiality by giving the Secretary of State for Health wide and ill-defined powers to determine what information should be disclosed in the public interest or for the improvement of patient care, without patients' consent.
We believe that any decision to override the citizen's right to privacy should be exceptional and must only be made—other than in an extreme medical emergency—after rigorous parliamentary scrutiny rather than by order of a Secretary of State. The Bill does not appear to provide for this.
We raised those issues in Committee. None of the Minister's assurances has persuaded us or, I believe, the groups that wrote to The Times that the provision makes for a better system. The fear of its use at the whim of a future Secretary of State provokes anxiety.
Perhaps our most important debate in Committee and tonight is on disease registries. We considered the Bill's impact on cancer registries in particular. Despite our reservations about the Secretary of State's power to require the publication of unanonymised data, we acknowledge the need for action to protect specific registries, including cancer registries.
No hon. Member should take disclosure of information without consent lightly. If the Secretary of State can do that
in the interests of improving patient care",
or "in the public interest", he must justify granting such sweeping and unprecedented powers to override the cornerstone of patient confidentiality between health professional and patient.
We are concerned—as were hon. Members on both sides of the Committee—that disease registries, including those relating to cardiac disease and cancer, should be able to continue their valued work. The Government's acceptance that decisions regarding the application of the subsection should be subject to affirmative resolution in both Houses of Parliament was a concession, but it does nothing to alter the basic facts.
The clause establishes sweeping powers far beyond what is required to ensure the continued viability of disease registries. That point was also raised in the amendments tabled for the British Medical Association by the Liberal Democrats in Committee. By dealing with specific applications of the subsection on a case-by-case basis, the Government find themselves in the position of permitting everything pending future exclusions. Why not provide clarity by stating what is permitted, as we have done in new clause I?
The Minister's comments in Committee appeared to be an attempt to establish procedure on the hoof. The proposals for the scrutiny of applications are at best


opaque and at worst obscure. That is particularly disappointing because there had been broad cross-party agreement on the necessity of maintaining disease registries. If the Government wish to develop and consult on proposals for wider measures, they should do so, rather than seek to rush through ill-thought-through ideas without any semblance of consultation. As I said, that is an unsatisfactory way to legislate.

Mr. Bercow: Does my hon. Friend agree that although the Government might not have devoted a great deal of thought to their proposals, they hale thus far certainly devoted a great number of words to them? I am pleased to see new clause 1, which pithily sets out the basis of what Her Majesty's Opposition would like to insert into the Bill in only 151 words, in contrast to the two and a half pages of unreconstructed and inexplicable verbiage on pages 58 to 60 of the Bill.

Dr. Fox: It is becoming habitual for me to agree with every word that my hon. Friend says. He has encapsulated the simple idea that if the Government mean something by the legislation, they ought to say it in the Bill. This part of the Bill has been drawn far too widely. If the Government's intention is as the Minister explained in Committee, that should be in the Bill.
The Minister's comments in Committee demonstrated the lack of thought that had gone into the subsections of clause 62, formerly clause 59. Other hon. Members and I highlighted in Committee instances in which the law could either be unworkable or render existing practices unworkable. The Minister spoke frequently of the need to ensure that regulations were adequate and correct. The degree of thought that he now recommends should have occurred before the framing of the Bill rather than during the final days of Committee.
Adequate thought has still not been given to the matter, and no satisfactory response has been given to the concern of GPs that the powers in the clause could make it mandatory for them to pass on identifiable patient information against their will, or against what they believe to be their patients' best interests. Will the Minister explain how that provision is sustainable in the face of principle 10 of the NHS plan, which states that the confidentiality of individual patients must be protected? The two concepts do not sit side by side.
The definition of patient information provides the Secretary of State with the power to ban the use of important and beneficial non-personal data, yet it also allows him to share identifiable health data at his own discretion. The clause states that the Secretary of State will use his powers "in the public interest", but that could easily become an excuse for the suppression of politically inconvenient data.
The explanatory notes suggest, as an example, that regulations to prohibit the use of anonymised patient information that is being used for a purpose
which is detrimental to the operation of the NHS
could fall within this definition. That could lead to situations in which cancer charities, among others, would not be able to conduct surveys of postcode rationing. This attempt to squeeze the life out of independent criticism of the NHS is reminiscent of the matter of the community health councils, which we shall discuss with the next group of amendments.
Last year, the Government abolished the patients charter in favour of a glossy brochure called "Your Guide to the NHS". A Government who are willing to use public money to publicise their party's health policies are a Government who would be willing to use possible restrictions on data to suit their party political policies.
I can make no better summary of the problems that we are trying to address in new clause 1 than to quote a letter to The Guardian signed by the president of the Royal College of Physicians, Sir George Alberti, as well as by the chairman of the Royal College of General Practitioners, the director of the World Health Organisation Uppsala monitoring centre, the chairman of the Patients Association and the chairman of the Depression Alliance. I quoted the letter in Committee, but it certainly bears being put on record again. It was written by people who are well respected in their field, and who cover the whole spectrum of the practice of medicine, of patient groups and of those who have devoted their lives to patient care. They state:
We wish to voice our serious concerns relating to Clause 59 of the Health and Social Care Bill, currently making its way through Parliament. It is the view of many in the medical community"—
I would say that it is almost a unanimous view—
that this clause would seriously threaten the ability of patient organisations, academics and the pharmaceutical industry to undertake important research and analysis, based on anonymous healthcare data, to improve the quality of patient care.
As it stands, the Bill provides the Secretary of State with such sweeping powers as to allow him to curtail or prohibit the collection of anonymised patient information, however derived, and conversely require or regulate the release of confidential information, without the patient's consent, for reasons that he judges appropriate. Remarkable as it may sound, these measures have been barely raised either in or out of parliament and were not included in the Government's National Plan.
It is our view that independent collection of information on the NHS enables analysis of information that the NHS does not collect or cannot provide easily to patient organisations, academics, public health bodies and the pharmaceutical industry. We have witnessed the value of such data in scrutinising the performance of the NHS and improving healthcare.
We urge the Government, in the spirit of open government, to withdraw this clause until adequate consultation has taken place. Only then can we reach an informed consensus about what controls are required both to protect patients but nonetheless allow access to anonymised information so necessary in monitoring and improving patient care.
Despite our pleas in Committee, we have been given nothing that makes it clear that the Government will incorporate a better definition into the Bill, so that Parliament and the courts will understand exactly what this information is to be used for. We need a better definition that will allow us to ensure that the provision is not at some point abused.
New clause 1 tries to tie down this part of the Bill to the purpose for which most of us believed it was to be used, involving one of the most important aspects of maintaining disease registries. If the Government do not accept the new clause, we can only believe that they want wider powers for reasons that go beyond those they gave in Committee as the justification for this part of the Bill. I commend new clause 1 to the House.

Dr. Brand: I declare an interest as a clinical practitioner, in that I work as an independent contractor to the health service as a general practitioner. It is relevant to make that declaration, as I would not like to be in conflict with the Secretary of State.
Renumbered clause 62 gives the Secretary of State powers to override the wishes of patients on the control of clinical data. I can tell the Secretary of State that most of my colleagues would join me in saying that the wishes and desires of their patients far outweigh any powers that any Secretary of State may care to take to himself or herself. Even the theoretical powers that the Secretary of State may be adopting could be profoundly unsettling for a profession that cares for patients above all, and could make the work of clinical practice a great deal more difficult.

Dr. Fox: To make the point even more explicitly, does the hon. Gentleman accept that, under the Bill, he and other practising doctors could find themselves in conflict with the Secretary of State for not providing data about a patient, or with the General Medical Council for providing it? Does he agree that that would be an unacceptable position for any practitioner?

Dr. Brand: That illustrates the position fairly clearly—and it would be a brave Secretary of State who took on a doctor acting in the interests of his patient. I hope that such circumstances never arise, but the Bill contains the potential for them.
6.30 pm
We accept that there is a problem with the maintenance of existing disease registers, especially cancer registers. In the past, consent was assumed far too frequently. In my view, it would be impractical to refer to people on existing registers in order to obtain formal consent to enable us to continue the excellent work that has been going on for decades, and has done so much to help us to understand the epidemiology and treatment of cancers and other diseases. However, I do not think there is any justification now for not asking for patients' consent at the time of the onset of their illness, or when they may be entering a register. Even after the probing in Committee, I still cannot understand why the Minister must take potentially wide-ranging powers if the aim is to maintain an important register and to deal with the anxieties of the Data Protection Registrar.
A problem has been created by, I think, parliamentary draftsmen rather than Ministers. There was an opportunity to introduce a bit of legislation, and the Government clearly needed an NHS Bill before the election. They looked at what they should put in the legislation that they envisaged, and this is part of that. There is a real problem with, for example, the existing cancer registries, but rather than concentrating on that the Government said, "Here is an opportunity to create a few more sweeping powers". There was then a great outcry.

Dr. Howard Stoate: As the House will know I, too, am a medical practitioner, and the regulations will therefore impinge on me to a large extent. Clause 62(5) states:
Regulations under subsection (3) may not make provision requiring the processing of confidential patient information for any purpose if it would be reasonably practicable to achieve that purpose otherwise than pursuant of such regulations".

Does the hon. Gentleman accept that the power will be used under the Bill only if it is impracticable to obtain information in any other way—in other words, by patient consent?

Dr. Brand: This is fascinating—it is what the legislation says, but the judge of whether the condition is fulfilled will be the Secretary of State, who will consult both Houses.
The Government, almost shocked by their own temerity in wishing to take these powers, obviously felt that they must put the brakes on. I appreciate the fact that they have done something quite unusual in requiring affirmative resolutions from both Houses, but that has happened only because they recognise that the powers they have given themselves are so ridiculous. They are far too wide and they are totally unnecessary.

Mr. Bercow: I do not want to criticise the hon. Gentleman, who is making an important point and speaks with some medical expertise. However, although I understand what he says about the parliamentary draftsmen, there is no way in which we can exonerate Ministers on the basis of errors of commission or omission by draftsmen: the Minister of State is responsible for what transpires.
Does the hon. Gentleman agree that clause 62(2)(c) is a model of ambiguity? It blathers on about level five on the standard scale,
or such other level as is prescribed",
and goes on to refer to
other procedures for enforcing any provisions of the regulations.
Why on earth can we not be told about those arrangements in the Bill?

Dr. Brand: As often, that was a valuable intervention. I think that there is a shared responsibility. It was noticeable that the only people who showed any enthusiasm in Committee were the officials, who agreed with every word that the Minister said. The rest of us shook our heads in some surprise.
It is clear that the Minister should take a small step—an interim step—to deal with the concerns about existing disease registers. I cannot understand why the Minister has taken the opportunity to assume powers in a completely different issue, that of anonymised data. By definition, that is not patient-identifiable information. It seems that the Government want an opportunity to reverse a slight that they may have experienced when they lost a case in the High Court. [HON. MEMBERS: "Henry VIII"' My memory does not go back as far as Henry VIII, and I do not understand the exact purpose of the "commercial" clause.
In Committee, I asked the Minister for a definition of "commercial". He referred me to the Town and Country Planning Acts, but they concern commercial premises rather than commercial activities. This is an important point. A good deal of research in this country is funded by drug companies and others in the health care field-not for altruistic reasons, but because they hope they will gain some commercial advantage. I am not saying that commercial activities are always benign: I think it improper for a drug company to try to work out the individual prescribing pattern of a particular general


practice or a particular general practitioner in order to target its promotion. We have received briefing from some commercial organisations, and I can assure the House that their activity is not designed to drive down drug costs; it is designed to increase their share of the drug market, often through the prescribing of their expensive patented drugs as against generic drugs.
I can see that the Secretary of State might want to consider a way of dealing with the need for information on NHS activities to be made freely available. All audit and a good deal of local government information is dependent on access to anonymised information. However, I do not think that what we are discussing makes sense.

Dr. Stoate: I appreciate the hon. Gentleman's point about audit, but we are talking about "prescribed commercial purposes". Audit is not commercial; it is for the good governance of the national health service, and for allied purposes. The provision relates specifically to the use of anonymised patient data for profit.

Dr. Brand: It depends on how the data are collected. I do not know my medical colleague's practice well, but I know that he has long been concerned with medical education, postgraduate education and training, as I have. I know how many training activities depend on a degree of sponsorship, and it is important to ensure that sponsorship does not corrupt the activities of the practice; but we are talking about a commercial activity nevertheless.
I understand why the Minister might be tempted to take powers, but I think he has adopted the wrong route. The most important step that he could have taken, as a Minister responsible for national health information, would have been to say that non-patient-identifiable information should be covered under freedom of information provisions, and accessible to all. That would make narrow commercial interests disappear, because it would not be in the interests of companies to produce the information—but the overall trends relating to drug use would still be explored, because that would be in the interests of if not just one drug company, drug companies generally.
I am profoundly unhappy about clause 62. As I said in the debate on the programme motion, it is ludicrous for the Government to propose such a provision before their own working party on patient confidentiality and associated issues has even reported _Although I welcome the fact they are establishing a formal body to advise them, there is already such a body and they have not waited for its advice before rushing us into legislation.
I think that it would be sensible for the Government to rethink clause 62, and I am glad that I am not the only one who thinks so. At the last Committee sitting, I gave a list of people who feel as I do. Since then, however, the list has grown from four to 11 signatories, representing a wide range of patient interests rather than commercial interests.
Should the House not divide on new clause 1, I would certainly seek to press amendment No. 15 to a Division. As the hon. Member for Buckingham (Mr. Bercow) said, that amendment is extremely elegant and cost-effective, with only 32 words.

Sir George Young: I hope that someone who is not a registered general practitioner may participate in the debate on this group of amendments.
Although the Government have tabled a very large number of amendments since the Committee rose last Thursday, they have not tabled any amendments to what was clause 59, now clause 62, which was the section of the Bill where I thought that they came under most sustained attack and were on the thinnest ice. I am very sad that they have not found an opportunity to meet some of those anxieties by tabling amendments of their own to new clause 62.
When I initially went through the Bill, before I went on to the Standing Committee, clause 59 was not one that immediately was drawn to my attention. At that stage, no one had written in about clause 59. Admittedly, it had not been in the NHS plan. It was only when the debates in Standing Committee began that letters came in.
The Government, in their definition of patient information, have managed to upset two wholly different groups of people. On the one hand, the Secretary of State has the potential power to ban the use of important and beneficial non-personal data, which has upset the pharmaceutical companies; on the other, the Government also allow sharing of identifiable health data without the subject's consent, which has of course upset the patient organisations.
Like the hon. Member for Isle of Wight (Dr. Brand), I have received representations from the chairman of the Patients Association, the director of the BMA Foundation for Aids and the director of the National AIDS Trust. They say that they have continuing concerns that clause 62 gives the Secretary of State
unprecedented powers to collect patient data without consent. It is an attack on patient confidentiality. The Government has not made a proper case for overriding patient consent, even for the cancer registries.
The chairman and directors also say, as my hon. Friend the Member for Woodspring (Dr. Fox) said, that the Government are
embarking on legislation without a due process of public consultation.
They also criticise the Government for drafting clause 62 very broadly and allowing
expedient use of identifiable patient information at the discretion of the executive, subject only to clawback safeguards",
which they find ineffectual.
Therefore, the Government are not only being attacked by patients' representatives for their definition of patient information, they are being criticised by the pharmaceutical companies for potentially prohibiting the use of anonymised data. Although those data are of commercial value, they are also of real benefit to academics, research institutions, consumer organisations, doctors, pharmacists and patients. In debate in Committee, the Minister, although he tried valiantly, never really justified the very wide definition of patient information in a manner that would allow him to forbid the use of anonymised data, which I believe are of wide benefit.
The assumption has been made that even the use of data without personal identification is, according to the explanatory notes,
not in the interests of patients".
I ask the Minister to have another go at defining
in the interests of patients" in a manner that will reassure the House that he does not seek to ban the use of anonymised information that could be of beneficial use by identifying drugs that have application but, for whatever reason, are not being prescribed in certain parts of the country.
6.45 pm
My final point is on rural pharmacies. Pharmacists receive additional revenue from commercial companies in return for anonymised data. That revenue is greatly welcomed by rural pharmacies across the country, which provide pharmaceutical cover to many housebound and many elderly patients through, for example, prescription delivery and collection and extended opening hours. The remuneration that pharmacists receive from the NHS has been reduced significantly in recent years. That has led them to look for new revenue sources. Income derived from prescription data can help provide additional employment, extend opening hours and be of broader use to the NHS.
I therefore ask the Minister to think again about that very wide definition and to see whether, even at this late stage, he cannot help the House by being more explicit about why he needs such very wide-sweeping powers.

Mr. Fabricant: On clause 59, which has become clause 62, the Bill's explanatory notes state:
The existing legal framework concerning the control of information relating to patients is complex and contains some uncertainties.
If the Bill's aim was to try to limit the complexity and uncertainties, it has patently failed to do so. As the hon. Member for Isle of Wight (Dr. Brand) said, there could well be conflict between the current terms of clause 62 and his responsibility to the General Medical Council. I would state the case even more strongly. As things have not changed so much in these days of new Labour that doctors no longer adhere to the Hippocratic oath—they still do-I wonder whether there would be a conflict between the Bill and the Hippocratic oath.
There is no question but that the Secretary of State could find himself in conflict with the General Medical Council or with the British Medical Association. The hon. Member for Isle of Wight said that a Secretary of State who willingly engaged in such conflict would have to be a brave Secretary of State. I say that he would have to be not so much brave as foolish. Nevertheless, although it is most unfortunate, foolish Secretaries of State are not unknown, particularly in this Government.
It is important to gather such information, particularly in disease registers, for epidemiological purposes. However, as both my hon. Friend the Member for Woodspring (Dr. Fox) and the hon. Member for Isle of Wight said, it is also important that we know where certain drugs are being used. I take the hon. Gentleman's point on generic drugs. Drug companies often push their own branded analgesics and other remedies that could be bought at one-tenth of the price as a generic product at Boots or another pharmacy. Paracetamol with codeine is available under the most marvellous names, pushed by drug companies at 10 times the price of a generic product. I can understand why the Government would be cautious in allowing that type of detailed information to fall into the hands of drug companies.
As my right hon. Friend the Member for North-West Hampshire (Sir G. Young) said, anonymised information does not fall into that category. During the past few weeks, I have become aware of how the National Institute for Clinical Excellence—which was established not so long ago by Health Ministers—has made recommendations on drugs that should be available for

doctors to prescribe free to their patients. In some areas, however, those drugs are still not available because of postcode funding. In some parts of the country, drugs are not available because the money for them is just not available. That has happened in the South Staffordshire health authority area, for example.
New clause 1 is still not as tight I would like it to be. It still gives considerable powers to the Secretary of State.

Mr. Bercow: I feel sure that the House will want to hear my hon. Friend expatiate on the subject of new clause 1. Before he does, would he turn his mind to clause 62(4)(c), which is part of the genesis of our objection to the Government's proposals? The subsection provides for regulations
for securing that, where prescribed patient information is processed by a person in accordance with the regulations, anything done by him in so processing the information shall be taken to be lawfully done despite any obligation of confidence owed by him in respect of it.
Does that not create a potentially hazardous and even sinister conflict of obligations? If not, would it not be better if the Government explained themselves more clearly?

Mr. Fabricant: My hon. Friend, as ever, has put his finger on the heart of the matter—if that is not mixing my metaphors. I think that doctors and the BMA have every reason to be alarmed by the far-reaching nature of clause 62. It is saying, in effect, that if the Secretary of State so decides, any question of confidentiality that might exist between a patient and his doctor can be swept aside and the information can be made public. Should we be surprised that so many august organisations acting on behalf of patients and people suffering from specific dysfunctions such as AIDS are concerned about the clause?

Dr. Stoate: The hon. Gentleman makes a fair point about the proposal, which does have potential problems. But surely he must accept that there have always been notifiable diseases that a doctor has a legal duty to notify, including patient-sensitive data. That even includes food poisoning. If a patient visits a GP with food poisoning, that doctor is under a legal obligation to notify the health authority, whether the patient likes it or not. We have always had the need for public health measures such as the notification of diseases and disease registers. Surely this is not a draconian and brand new measure; it is merely what has gone on for some time, but in a slightly different way.

Mr. Fabricant: The hon. Gentleman misses the point and does so because he is a doctor and not a lawyer. Of course he is right that this sort of data have always been collected for epidemiological purposes. That is tremendously important. When the Conservative Government introduced trusts—which the present Government are attempting to build on—we made sure that epidemiological research would continue nationally. Clause 62(4)(c) makes it clear that the information so provided may not now be anonymous. That is the difference. In the past, doctors would notify the NHS through its various agencies of a particular event


or dysfunction. However, there was no obligation previously to provide the name of the person suffering from such a dysfunction.

Dr. Stoate: This is an important point. The notifiable disease register contains patients' details; it must. If a patient of mine were to get tetanus, polio, typhoid, cholera, hepatitis or even food poisoning, I would have to identify that person to the local health authority by name, age and address, as the patient would have to be contacted and followed up for public health reasons. Patient-sensitive data have always been held.

Mr. Fabricant: But that data wet e always confidential. The point is that now they may not be.

Dr. Brand: I wish to clarify something said by the hon. Member for Dartford (Dr. Stoate). Epidemiology can deal with anonymised data, and it is perfectly proper that it should do so. Notifiable diseases are notifiable because they may present a risk to the patient if not treated. More importantly, they present a direct risk to people coming into contact with the disease. That is not an argument that can be applied to most registers.

Mr. Fabricant: That is the point. [Laughter.] It is all very well people who have just walked into the Chamber laughing at this exchange—it demonstrates why time is needed for Members such as myself, who did not serve on the Committee, to explore the meaning of the clause. That is what this Parliament is all about, for God's sake. But the Government are saying that these important issues have to be terminated at 9 o'clock. It is all very well for Labour Members to laugh and say that the issues are not important, but the BMA and the other organisations to which my right hon. Friend the Member for North-West Hampshire referred are worried. As the hon. Member for Isle of Wight said, it is one thing Lo discuss notifiable diseases such as tuberculosis, or other diseases that can generate epidemics; it is another to talk about other forms of disease, details of which may now be placed in the public domain by virtue of the Bill

Dr. Fox: Does my hon. Friend agree that it is not a question of what has happened In the past—even in specific cases, such as notifiable diseases—or even what is likely to happen with the use of data, but what could happen under the wide powers in the Bill?

Mr. Fabricant: My hon. Friend is right; that is why there is concern among organisations such as the BMA. We recognise that some form of register needs to be kept-that is why my hon. Friend has tabled new clause 1, which still gives considerable powers to the Secretary of State. Subsection (2) says that
disease registers' means those registers of incidence of specified diseases as the Secretary of State shall by regulation prescribe.
The Secretary of State will be free to prescribe, but by regulation which requires the scrutiny of this House; that is right and proper. The definition of "prescribed patient information" is of great concern to some doctors inside this House and to the BMA. In the new clause, the definition is
patient information specified in or determined in accordance with regulations made by the Secretary of State under this section.

Again, we are giving the Secretary of State latitude but, first, the Secretary of State must prescribe that information in legislation or regulation, which needs to be scrutinised by the House. The same definition applies to "processing".
There is clearly concern among the medical profession about confidentiality. It is one thing to provide information to the NHS about those dysfunctions that may produce an epidemic in this country; it is another to give far-reaching powers to an unscrupulous Secretary of State to require personal information given by patients to doctors or learned by doctors from their patients to be given to him, and for that information then to appear in the public domain.
It is no surprise to me that the BMA should be concerned. What surprises me is that Labour Members do not share that concern.

Mr. Denham: This is an important debate on an important matter. It is a shame that, so far, it has not lived up to the importance of the subject.
I think that the characterisation of the clause that has been advanced is not justified by what is in the Bill or by the Government's intentions. As I hope to make clear, the debate has not assessed properly the debate outside the House about the use of patient information. Contributors to that debate have said that the Bill should not contain the proposals that it does contain, or that the proposals should be different, or that they should not be introduced now, and so on.
7 pm
As I said in Committee, the Government are starting from a position in which the use of non-anonymised patient information in the NHS is widespread, and has been so for years. The problem that we must tackle is to establish the principle of informed consent on the use of patient information from a starting point that has not made the use of informed consent the principle by which the NHS is guided.
The Government's task with this clause is to find the best way to move as quickly as possible to deal with a problem that was never tackled by the previous Government. They tolerated it, and never criticised its existence, but everyone accepts that the situation is different now. I do not entirely blame the previous Government, because there has been a sea change in attitudes towards the handling of patient information, both among the public and members of the medical profession. I could criticise the previous Government for many things, but it would not be fair to judge Ministers of 10 or 15 years ago by the standards of today. The standards applicable to a lot of the issues to do with patient consent were different then.
I have described the Government's task with the clause. It had to be accomplished at a time when we were not entirely in control of the time scale. That is why the hon. Member for Isle of Wight (Dr. Brand) was wrong to say that we should have waited.
As everyone knows, the General Medical Council, exercising its responsibilities as a professional self-regulatory body, last summer issued guidance that had an immediate impact on the collection of data by cancer registries. As I said in Standing Committee, it issued


further guidance in November in response to the ensuing debate. That guidance appeared after the publication of the NHS plan, and said that the professional obligation would not be asserted until October 2001.
If the Government had not taken the earliest possible opportunity, represented by this Bill, to put a proper statutory framework around the use of patient information, I have every reason to believe that the GMC would have felt under a professional obligation to carry through its advice. That would have had an immediate impact on the operation of cancer registries and other activities. The Government are therefore not in control of the time scale, which is why I believe that we are right to go ahead with the proposal and why it would have been wrong to wait.
The hon. Member for Isle of Wight referred to work in the Department on the use of patient information. That work is part of a different exercise looking at all the changes that need to be made across the NHS to put our use of information on a satisfactory basis. We will not have the results until later this year, but it is right for us to get right the statutory framework contained in the Bill.

Dr. Fox: I understand that the Minister is genuine in what he says about what the Government's wish for the Bill, but why has the clause drawn so much criticism from such a wide range of bodies? They cannot all have misinterpreted what the clause is capable of, so surely this is a fault in the drafting. It is not the intention of the Government but the use to which the provisions could be put that has caused such widespread anxiety among the many groups mentioned in the debate.

Mr. Denham: There is disagreement outside the House, as well as in it, about the relevant issues. For example, Professor Martin Vessey of the department of public health at Oxford university wrote to me about the work that he carried out with Dr.—now Sir—Richard Doll in the 1960s investigating the links between leg vein thrombosis, pulmonary embolism and women who had been using oral contraceptives. He wrote about the necessity of using patient data at the time.
I have received a letter from Leslie Davis of the National Perinatal Epidemiology Unit, in which he states:
I support clause 59 in providing support for the continuation of important transmission of health information. It will give the NHS and other key agencies guarding the health of the public the temporary ability to maintain critical flows of public health information.
We have received correspondence from Dr. Monica Roche and Professor David Foreman of the United Kingdom Association of Cancer Registries. The letter states:
We are writing on behalf of the United Kingdom Association of Cancer Registries to ask for your support in ensuring that clause 59 of the Health and Social Care Bill is passed. Without this enabling legislation the national system for monitoring cancer will have collapsed by the end of the year.
The attached briefing note goes on to explain why the approach adopted in the Bill is necessary. Sir Richard Doll from the clinical trials service unit and the epidemiological studies unit at the university of Oxford has written to state:
It is, we believe, important for the future health of people in this country that a legislative framework should exist that ensures that public health surveillance and medical research can continue when

they require information that is available in patients' medical records, without the need to obtain individual patients' consent for their use when this is impractical. In so far as clause 59 will permit this for bona fide research workers on a confidential basis, we strongly support it.
I could continue with examples from other correspondence, but the point is not simply that the correspondence illustrates that there is a debate in the medical profession about how to approach this matter. I do not think that there is a debate about informed patient consent, but there is a debate about how we move from where we are, and the practices that have been developed over many years, and reach a better system in the future.
I chose the correspondence that I did because, with the exception of the cancer registries, they referred to activities that fall outside the definition of cancer registries. I gave other examples in Standing Committee. That is why I believe that the approach adopted in the Bill, which has many built-in safeguards, is better than attempting to list or predict in a narrow way in the Bill all the acceptable uses of information.

Dr. Brand: The Minister has used very valid examples, and they all involve bits of research where problems can be overcome by anonymising the clinical data. That is why it is so relevant to say that the outcome of his own working party's research on confidentiality and the processing of clinical data should be available before we decide about what should be the proper legislative proposals that the Minister needs. If the Minister would accept amendment No. 15 or new clause 1, his anxieties over cancer registries would be overcome and he would have time to reflect on whether he needs to take powers that are as wide as those contained in the Bill. We have no doubts about the Minister's intent, but we have great worries about what is in a Bill that does not mention patient confidentiality anywhere.

Mr. Denham: I think that the hon. Gentleman has simply—and inadvertently, I am sure—not really looked at the Bill and the safeguards that it contains. He asserts that all the examples that I gave involved work that could be undertaken with anonymised patient data. I do not have confidence that the hon. Gentleman is right about all the research that I mentioned, or about other legitimate, important and pressing research that might be undertaken.
I hope that, in tilt not too distant future, the NHS IT systems will be fully in place, so enabling electronic patient records to be kept and anonymised patient data to be used routinely. However, I am not sure that we have reached that point yet. That is why the Bill contains two important safeguards that have been included from the outset.
First, the Bill limits the use of the powers to medical purposes where there is a benefit to patient care and public health. Secondly, it limits their use to circumstances in which there is no reasonably practical alternative. The latter is not a once-and-for-all test, and does not mean that once a particular activity slips past the test it is there for ever and a day, because the Secretary of State is required by the Bill to review each set of regulations every year.
Therefore, any activity will have to pass the "practical alternative" test and, as I explained in Standing Committee, it must be looked at by an advisory group. That group will involve organisations such as the GMC, the BMA, research councils, patients' organisations and


others. If they advise the Secretary of State that there is no reasonably practical alternative, the Secretary of State then has to make regulations. He then has to consult on the regulations.
That is not an end to the matter because those regulations have to come before Parliament, not, as is so often the case, through the negative resolution procedure, but under the affirmative resolution, which requires a positive vote by both Houses of Parliament. Even if that is achieved, the following year and every year after that, the Secretary of State has to satisfy himself, no doubt by taking advice, that the conditions that led him to believe that anonymised data should not be used no longer apply.
That is a pretty robust set of safeguards, but the hon. Member for Woodspring (Dr. Fox) painted a picture of the Secretary of State getting out of bed one morning and making up his mind on this matter, as if that were an end to it. That is so far from the truth that it is outrageous. Such caricatures are one of the reasons for the amount of concern about the Bill.
On the second issue, which was raised by several hon. Members, including the right hon. Member for North-West Hampshire (Sir G. Young), I suspect that there is simply a difference of opinion in the House, as there was in Committee. We were concerned about the activities of a company called Source Information. We believed that its processing of anonymised patient information led, or was likely to lead, to a targeted marketing effort that was not beneficial to the NHS, so we sought to restrict its activities. We lost that case in court on the basis that there had been no breach of confidence, and we are not attempting to overturn that judgment in the Bill. However, we are, as the judge invited us to do, taking the necessary powers to restrict such activity in future.
It is clearly ridiculous to suggest that this Government, who have published more information about the NHS than any previous Government, are engaged in an exercise to suppress information or criticism. I accept that the hon. Member for Woodspring thinks that in the distant future he might be Secretary of State and that he would use the legislation differently. He invited me to use the precautionary principle to deny him that power. However, it is necessary to take action to protect the interests of the NHS, and with the amendments that were made in Committee, the Bill is a proportionate response to that need.
Since the debate in Committee, the Association of Medical Research Charities has written to us to say:
We welcome the Government amendment to subsection two of this Clause which has addressed some serious concerns about the application of the law. AMRC believes that there is merit in including in the Bill a Clause that allows the appropriate use of anonymised patient data for the purposes of research but also makes provision for clear and robust safeguards.
That is what I believe we are doing.

Dr. Fox: As I said in opening the debate on the new clause, we believe that in its major provisions this Bill is centralising and authoritarian. Clause 62 is such a provision, and that is why we tabled new clause 1.
There are two main objections to clause 62. It allows the Secretary of State to control anonymised data for reasons that he may determine in future, and rather than detailing when information can be used, the Bill says that the Secretary of State knows best and will exclude its use where he sees fit.
As the hon. Member for Isle of Wight (Dr. Brand) pointed out, the Bill will force doctors to divulge identifiable patient data against patients' will, which is entirely unacceptable. My right hon. Friend the Member for North-West Hampshire (Sir G. Young) rightly said that in Committee the Government came under sustained attack on clause 62. The Minister gave us a long explanation of the mechanics that he believed would provide safeguards, yet nothing has been added to the Bill to make it more explicit or enforceable.
My hon. Friend the Member for Lichfield (Mr. Fabricant) said that what matters is not what happened in the past or even the Government's intentions, but what could be done within the scope of the Bill. That is what worries Members of the House and the many outside groups who have written to us. As the hon. Member for Isle of Wight said, we are legislating even before the end of the Government's consultation process on patient information. That is a bad way to make law; the Bill is bad law, and at some point Ministers will return to the House to reconsider it. It is nothing less than the nationalisation of patient data, and we oppose it. I should like to press new clause 1 to a vote.

Question put, That the clause be read a Second time:—

The House divided: Ayes 167, Noes 306.

Division No. 124]
[7.14 pm


AYES


Ainsworth, Peter (E Surrey)
Cran, James


Allan, Richard
Curry, Rt Hon David


Amess, David
Davey, Edward (Kingston)


Ancram, Rt Hon Michael
Davies, Quentin (Grantham)


Arbuthnot, Rt Hon James
Davis, Rt Hon David (Haltemprice)


Ashdown, Rt Hon Paddy
Day, Stephen


Atkinson, Peter (Hexham)
Duncan, Alan


Baker, Norman
Emery, Rt Hon Sir Peter


Baldry, Tony
Evans, Nigel


Ballard, Jackie
Fabricant, Michael


Beggs, Roy
Fallon, Michael


Beith, Rt Hon A J
Fearn, Ronnie


Bercow, John
Flight, Howard


Beresford, Sir Paul
Forth, Rt Hon Eric


Blunt, Crispin
Fowler, Rt Hon Sir Norman


Body, Sir Richard
Fox, Dr Liam


Boswell, Tim
Gale, Roger


Bottomley, Peter (Worthing W)
Garnier, Edward


Bottomley, Rt Hon Mrs Virginia
George, Andrew (St Ives)


Brady, Graham
Gibb, Nick


Brake, Tom
Gidley, Sandra


Brand, Dr Peter
Gill, Christopher


Brazier, Julian
Gillan, Mrs Cheryl


Breed, Colin
Gorman, Mrs Teresa


Brooke, Rt Hon Peter
Greenway, John


Browning, Mrs Angela
Grieve, Dominic


Bruce, Malcolm (Gordon)
Gummer, Rt Hon John


Burnett, John
Hague, Rt Hon William


Burns, Simon
Hamilton, Rt Hon Sir Archie


Burstow, Paul
Hammond, Philip


Butterfill, John
Hancock, Mike


Cable, Dr Vincent
Harris, Dr Evan


Cash, William
Harvey, Nick


Chapman, Sir Sydney (Chipping Barnet)
Hayes, John



Heald, Oliver


Chope, Christopher
Heath, David (Somerton & Frome)


Clark, Dr Michael (Rayleigh)
Heathcoat-Amory, Rt Hon David


Clarke, Rt Hon Kenneth (Rushcliffe)
Hogg, Rt Hon Douglas



Horam, John


Collins, Tim
Howard, Rt Hon Michael


Cormack, Sir Patrick
Howarth, Gerald (Aldershot)


Cotter, Brian
Hughes, Simon (Southwark N)






Hunter, Andrew
Robertson, Laurence (Tewk'b'ry)


Jack, Rt Hon Michael
Roe, Mrs Marion (Broxbourne)


Jackson, Robert (Wantage)
Russell, Bob (Colchester)


Jenkin, Bernard
St Aubyn, Nick


Johnson Smith, Rt Hon Sir Geoffrey
Sanders, Adrian



Sayeed, Jonathan


Jones, Nigel (Cheltenham)
Shephard, Rt Hon Mrs Gillian


Keetch, Paul
Shepherd, Richard


Kennedy, Rt Hon Charles (Ross Skye & Inverness W)
Simpson, Keith (Mid-Norfolk)



Smith, Sir Robert (W Ab'd'ns)


Key, Robert
Smyth, Rev Martin (Belfast S)


Kirkbride, Miss Julie
Soames, Nicholas


Laing Mrs Eleanor
Spelman, Mrs Caroline


Lait, Mrs Jacqui
Stanley, Rt Hon Sir John


Lansley, Andrew
Steen Anthony


Leigh, Edward
Streeter, Gary


Letwin, Oliver
Stunell, Andrew


Lewis, Dr Julian (New Forest E)
Swayne, Desmond


Lidington, David
Syms, Robert


Livsey, Richard
Taylor, Ian (Esher & Walton)


Lloyd, Rt Hon Sir Peter (Fareham)
Taylor, John M (Solihull)


Loughton, Tim
Taylor, Matthew (Truro)


Luff Peter
Taylor, Sir Teddy


Lyell, Rt Hon Sir Nicholas
Thomas Simon (Ceredigion)


McCrea, Dr William
Tonge, Dr Jenny


McIntosh, Miss Anne
Tredinnick, David


MacKay, Rt Hon Andrew
Trend, Michael


Maclean, Rt Hon David
Tyler, Paul


McLoughlin, Patrick
Viggers, Peter


Major, Rt Hon John
Walter, Robert


Malins, Humfrey
Waterson, Nigel



Webb, Steve


Mates, Michael
Whitney, Sir Raymond


Michie, Mrs Ray (Argyll & Bute)
Whittingdale, John


Moore, Michael
Wilkinson, John


Moss, Malcolm
Willetts, David


Nicholls, Patrick
Willis, Phil


Oaten, Mark
Wilshire, David


O'Brien, Stephen (Eddisbury)
Winterton, Mrs Ann (Congleton)


Ottaway, Richard
Winterton, Nicholas (Macclesfield)


Page, Richard
Yeo, Tim


Pickles, Eric
Young, Rt Hon Sir George


Prior, David



Randall, John
Tellers for the Ayes:


Redwood, Rt Hon John
Mr. James Gray and


Rendel, David
Mr. Geoffrey Clifton-Brown.




NOES


Adams, Mrs Irene (Paisley N)
Belts, Clive


Ainger, Nick
Blackman, Liz


Ainsworth, Robert (Cov'try NE)
Blizzard, Bob


Allen, Graham
Boateng, Rt Hon Paul


Anderson, Rt Hon Donald (Swansea E)
Borrow, David



Bradshaw, Ben


Anderson, Janet (Rossendale)
Brinton, Mrs Helen


Armstrong, Rt Hon Ms Hilary
Brown, Russell (Dumfries)


Ashton, Joe
Browne, Desmond


Atkins, Charlotte
Buck, Ms Karen


Austin, John
Burden, Richard


Bailey, Adrian
Burgon, Colin


Banks, Tony
Byers, Rt Hon Stephen


Barnes, Harry
Campbell, Mrs Anne (C'bridge)


Battle, John
Campbell, Ronnie (Blyth V)


Bayley, Hugh
Campbell-Savours, Dale


Beard, Nigel
Cann, Jamie


Beckett, Rt Hon Mrs Margaret
Caplin, Ivor


Begg, Miss Anne
Cawsey, Ian


Bell, Martin (Tatton)
Chapman, Ben (Wirral S)


Bell, Stuart (Middlesbrough)
Chaytor, David


Benn, Hilary (Leeds C)
Clapham, Michael


Benn, Rt Hon Tony (Chesterfield)
Clark, Rt Hon Dr David (S Shields)


Bennett, Andrew F
Clark, Paul (Gillingham)


Benton, Joe
Clarke, Charles (Norwich S)


Bermingham, Gerald
Clarke, Eric (Midlothian)


Berry, Roger
Clarke, Rt Hon Tom (Coatbridge)


Best, Harold
Clelland, David





Coaker, Vernon
Howarth, Rt Hon Alan (Newport E)


Coffey, Ms Ann
Howarth, George (Knowsley N)


Cohen, Harry
Howells, Dr Kim


Coleman, Iain
Hoyle, Lindsay


Colman, Tony
Hughes, Ms Beverley (Stretford)


Connarty, Michael
Hughes, Kevin (Doncaster N)


Cooper, Yvette
Humble, Mrs Joan


Corbett, Robin
Hutton, John


Corbyn, Jeremy
Iddon, Dr Brian


Cousins, Jim
Illsley, Eric


Cox, Tom
Jackson, Ms Glenda (Hampstead)


Cranston, Ross
Jackson, Helen (Hillsborough)


Crausby, David
Jamieson, David


Cryer, John (Hornchurch)
Jenkins, Brian


Cummings, John
Johnson, Alan (Hull W & Hessle)


Cunningham, Rt Hon Dr Jack (Copeland)
Jones, Mrs Fiona (Newark)



Jones, Helen (Warrington N)


Curtis-Thomas, Mrs Claire
Jones, Ms Jenny (Wolverh'ton SW)


Darling, Rt Hon Alistair



Darvill, Keith
Jones, Jon Owen (Cardiff C)


Davey, Valerie (Bristol W)
Jones, Dr Lynne (Selly Oak)


Davidson, Ian
Jones, Martyn (Clwyd S)


Davies, Rt Hon Denzil (Llanelli)
Jowell, Rt Hon Ms Tessa


Davis, Rt Hon Terry (B'ham Hodge H)
Joyce, Eric



Kaufman, Rt Hon Gerald


Dawson, Hilton
Keeble, Ms Sally


Denham, Rt Hon John
Keen, Alan (Feltham & Heston)



Dismore, Andrew
Keen, Ann (Brentford & Isleworth)


Dobbin, Jim
Kelly, Ms Ruth


Dobson, Rt Hon Frank
Kemp, Fraser


Donohoe, Brian H
Kennedy, Jane (Wavertree)


Doran, Frank
Kidney, David


Drew, David
Kilfoyle, Peter


Drown, Ms Julia
King, Andy (Rugby & Kenilworth)


Dunwoody, Mrs Gwyneth
Kumar, Dr Ashok


Eagle, Angela (Wallasey)
Ladyman, Dr Stephen


Eagle, Maria (L'pool Garston)
Lammy, David


Edwards, Huw
Laxton, Bob


Efford, Clive
Lepper, David


Ellman, Mrs Louise
Leslie, Christopher


Ennis, Jeff
Levitt, Tom


Etherington, Bill
Lewis, Ivan (Bury S)


Fisher, Mark
Liddell, Rt Hon Mrs Helen


Fitzpatrick, Jim
Lock, David


Fitzsimons, Mrs Loma
Love, Andrew


Flint, Caroline
McAvoy, Thomas


Flynn, Paul
McCabe, Steve


Foster, Rt Hon Derek
Macdonald, Calum


Foulkes, George
McDonnell, John



George, Rt Hon Bruce (Walsall S)
McFall, John


Gerrard, Neil
McGuire, Mrs Anne


Gibson, Dr Ian
McIsaac, Shona


Gilroy, Mrs Linda
McKenna, Mrs Rosemary


Goggins, Paul
Mackinlay, Andrew


Golding, Mrs Llin
McNamara, Kevin


Griffiths, Jane (Reading E)
McNulty, Tony


Griffiths, Nigel (Edinburgh S)
MacShane, Denis


Griffiths, Win (Bridgend)
Mactaggart, Fiona


Grocott, Bruce
McWalter, Tony


Grogan, John
McWilliam, John


Gunnell, John
Mahon, Mrs Alice


Hain, Peter
Mallaber, Judy


Hanson, David
Mandelson, Rt Hon Peter


Harman, Rt Hon Ms Harriet
Marsden, Gordon (Blackpool S)


Healey, John
Marsden, Paul (Shrewsbury)


Henderson, Doug (Newcastle N)
Marshall, David (Shettleston)


Hendrick, Mark
Marshall, Jim (Leicester S)


Hepburn, Stephen
Martlew, Eric


Heppell, John
Meacher, Rt Hon Michael


Hesford, Stephen
Meale, Alan


Hewitt, Ms Patricia
Merron, Gillian


Hinchliffe, David
Michael, Rt Hon Alun


Hodge, Ms Margaret
Michie, Bill (Shef'ld Heeley)



Hoon, Rt Hon Geoffrey
Milburn, Rt Hon Alan


Hope, Phil
Miller, Andrew


Hopkins, Kelvin
Mitchell, Austin






Moffatt, Laura
Soley, Clive


Morgan, Ms Julie (Cardiff N)
Southworth, Ms Helen


Morris, Rt Hon Ms Estelle (B'ham Yardley)
Spellar, John



Squire, Ms Rachel


Morris, Rt Hon Sir John (Aberavon)
Starkey, Dr Phyllis



Steinberg, Gerry


Mullin, Chris
Stewart, Ian (Eccles)


Murphy, Denis (Wansbeck)
Stinchcombe, Paul


Murphy, Jim (Eastwood)
Stoate, Dr Howard


Murphy, Rt Hon Paul (Torfaen)
Strang, Rt Hon Dr Gavin


Naysmith, Dr Doug
Stringer, Graham


O'Brien, Bill (Normanton)
Stuart, Ms Gisela


O'Hara, Eddie
Taylor, Rt Hon Mrs Ann (Dewsbury)



Olner, Bill



O'Neill, Martin
Taylor, Ms Dari (Stockton S)


Organ, Mrs Diana
Taylor, David (NW Leics)


Pearson, Ian
Taylor, Rt Hon John D (Strangford)


Perham, Ms Linda
Temple-Morris, Peter


Pickthall, Colin
Thomas, Gareth R (Harrow W)


Pike, Peter L
Timms, Stephen


Pond, Chris
Tipping, Paddy


Pope, Greg
Todd, Mark


Pound, Stephen
Touhig, Don


Prentice, Ms Bridget (Lewisham E)
Trickett, Jon


Prentice, Gordon (Pendle)
Turner, Dennis (Wolverh'ton SE)


Primarolo, Dawn
Turner, Dr Desmond (Kemptown)


Prosser, Gwyn
Turner, Dr George (NW Norfolk)


Purchase, Ken
Turner, Neil (Wigan)


Quin, Rt Hon Ms Joyce
Twigg, Derek (Halton)


Rammell, Bill
Twigg, Stephen (Enfield)


Raynsford, Nick
Vaz, Keith


Reed, Andrew (Loughborough)
Vis, Dr Rudi


Robertson, John (Glasgow Anniesland)
Walley, Ms Joan



Ward, Ms Claire


Robinson, Geoffrey (Cov'try NW)
Wareing, Robert N


Roche, Mrs Barbara
Watts, David


Rogers, Allan
White, Brian


Rooker, Rt Hon Jeff
Whitehead, Dr Alan


Rooney, Terry
Wicks, Malcolm


Ross, Ernie (Dundee W)
Williams, Rt Hon Alan (Swansea W)


Rowlands, Ted



Roy, Frank
Williams, Alan W (E Carmarthen)


Russell, Ms Christine (Chester)
Williams, Mrs Betty (Conwy)


Ryan, Ms Joan
Wills, Michael


Sarwar, Mohammad
Winnick, David


Savidge, Malcolm
Winterton, Ms Rosie (Doncaster C)


Sawford, Phil
Woodward, Shaun


Sedgemore, Brian
Woolas, Phil


Shipley, Ms Debra
Wray, Janes


Singh, Marsha
Wright, Anthony D (Gt Yarmouth)


Skinner, Dennis
Wright, Tony (Cannock)


Smith, Rt Hon Andrew (Oxford E)
Wyatt, Derek


Smith, Miss Geraldine (Morecambe & Lunesdale)




Tellers for the Noes:


Smith, Jacqui (Redditch)
Mr. Jim Dowd and


Smith, John (Glamorgan)
Mr. Mike Hall.

Question accordingly negatived.

New Clause 2

COMMUNITY HEALTH COUNCILS: SCHEME FOR REFORM

".—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations setting out a scheme for the reform of Community Health Councils in England.

(2) The scheme set out by the Secretary of State in regulations under subsection (1) above shall extend t3 all parts of the health service (including the provision of Part [I services under the 1977 Act).

(3) The Secretary of State may make regulations providing for access by members of a Community Health Council to premises from which services under Part II of the 1077 Act are provided.

(4) The scheme set out by the Secretary of State in regulations under subsection (1) shall provide for the proper representation of the population in the area served by a Community Health Council on that Council.

(5) Regulations under subsection (1) may not be made unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament.'.—[Dr. Fox.]

Brought up, and read the First time.

Dr. Fox: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker: With this it will be convenient to discuss the following: New clause 7—Community Health Councils: additional functions—

".—(1) The Secretary of State shall make regulations providing in relation to Community Health Councils ("Councils") in England for—

(a) the delivery by Councils of support and advocacy services to patients and others with complaints about health services;
(b) Councils to advise and make recommendations to the relevant overview and scrutiny committee, health authority and trust about matters arising from complaints;
(c) reports on the operation of the complaints support service to be compiled by Councils and provided to the Secretary of State to the relevant overview and scrutiny committee, health authority, trust, and other appropriate organisations;
(d) annual reports to be published by Councils detailing the arrangements maintained in that year for obtaining the views of patients;
(e) the establishment of sub-committees of each Council to be known as Patients' Forums, for each NHS and primary care trust in the district of the Council, made up of representatives of the Council, and co-opted representatives of the local authority overview and scrutiny committee, patients, carers and the wider community, with duties to—

(i) monitor and review the operation of services provided by, or under arrangements made by, the trust to which it relates;
(ii) obtain the views of patients, carers and the wider community about those services and report on those views to the Council and the trust;
(iii) provide advice and make reports and recommendations about matters relating to those services to the Council, the relevant Health Authority, and the trust to which it relates,
(iv) make available to patients, carers and the wider community advice and information about those services;
(v) in the case of primary care services carry out the functions as may be prescribed by regulations made by the Secretary of State;
(vi) carry out such other functions as may be prescribed by regulations made by the Secretary of State;

(f) the appointment of representatives from the Patients' Forum as non-executive directors to the board of the trust to which the Forum relates;
(g) for functions of Patients' Forums to be performed under joint arrangements between Councils, where such arrangements are appropriate to meet the needs of their communities;
(h) the extension of Councils' rights of inspection to all premises from which services as defined in subsection (3) are provided and;


(i) matters of concern which Councils may refer to the National Institute for Clinical Excellence, the Commission for Health Improvement, the Audit Commission and the Secretary of State.

(2) References in subsection (1) to "services" are references to—

(a) services provided as part of the health service (within the meaning of the 1977 Act) in England;
(b) services provided in England in pursuance of arrangements under regulations under section 31 of the Health Act 1999; and
(c) services provided elsewhere in pursuance of such arrangements with a local authority in England.

(3) In subsection (2)—

(a) "relevant overview and scrutiny committee", means the committee of the council or councils whose district corresponds, or is included within, the community represented by the Council.
(b) "relevant Health Authority" in subsection (1)(e) in relation to a Patients' Forum for a Primary Care Trust, means the Health Authority whose area is, or includes, the area for which the trust is established.

(4) Before making regulations under this section the Secretary of State shall consult with Councils and such patients' and carers' organisations as he shall consider appropriate.'.

New clause 8—Community Health Councils in Wales—

'. The National Assembly for Wales may, by order, in relation to Community Health Councils in Wales, make provision corresponding to the provision which the Secretary of State must, by regulations, make in relation to Community Health Councils in England under section (Community Health Councils: additional functions).'.

New clause 9—Patients' Councils—

'.—(1) The Secretary of State shall by regulations provide for the establishment of bodies to be known as Patients' Councils (referred to in this section as "Councils") the members of which are to be appointed in each case by two or more Patients' Forums.

(2) The regulations shall provide for determining—

(a) the Patients' Forums by which the members of a Council are to be appointed, and
(b) the area in relation to which the functions of a Council are exercisable.

(3) The functions of a Council are—

(a) to facilitate the co-ordination by member Forums of their activities;
(b) to make reports to health authorities, local authorities and their committees and to the Secretary of State in accordance with the regulations;
(c) to carry out such arrangements as may be made with the Council under section 19A of the 1977 Act (independent advocacy services);
(d) such other functions as the regulations may prescribe.

(4) The "member Forums" of a Council are the Patients' Forums by which its members are for the time being appointed.'.

New clause 10—Independent advocacy services—

'. After section 19 of the 1977 Act there shall be inserted—

"Independent advocacy services

19A.—(1) It is the duty of the Secretary of State to arrange, to such extent as he considers necessary to meet all reasonable requirements, for the provision of independent advocacy services.

(2) "Independent advocacy services" are services providing assistance (by way of representation or otherwise) to individuals making or intending to make—

(a) a complaint under a procedure operated by a health service body or independent provider,

(b) a complaint to the Health Service Commissioner for England or the Health Service Commissioner for Wales,
(c) a complaint of a prescribed description which relates to the provision of services as part of the health service and

(i) is made under a procedure of a prescribed description. Or
(ii) gives rise, or may give rise, to proceedings of a prescribed description.

(3) In subsection (2)—
health' service body" means a body which, under section 2(1) or (2) of the Health Service Commissioners Act 1993, is subject to investigation by the Health Service Commissioner for England or the Health Service Commissioner for Wales;
independent provider" means a person who, under section 2B(1) or (2) of that Act, is subject to such investigation.

(4) The Secretary of State may make such other arrangements as he thinks fit for the provision of assistance to individuals in connection with complaints relating to the provision of services as part of the health service.

(5) In making arrangements under this section the Secretary of State must have regard to the principle that the provision of services under the arrangements should, so far as practicable, be independent of toy person who is the subject of a relevant complaint or is involved in investigating or adjudicating on such a complaint.

(6) Before making arrangements under this section in respect of complaints relating to the provision of any services. the Secretary of State shall consult—

(a) any relevant Patients' Council, and
(b) such other persons as he considers appropriate.

(7) A Patients' Council is, for the purposes of subsection (6)(a), a relevant Council if the services concerned are ones to which functions of a member Forum of the Council relate.

(8) The Secretary of State may make payments to any person in pursuance of arrangements under this section.".'.

Amendment No. 2, in page 9, line 6, leave out clause 11.

Government amendments Nos. 144 to 150.

Amendment No. 3, in page 10, line 18, leave out clause 12.

Amendment No. 4, in page 10, line 30, leave out clause 13.

Amendment No. 5, in page 10, line 38, leave out clause 14.

Amendment No. 24, in clause 14, page 10, line 39, at end insert "and Patients" Councils ("Councils").".

Government amendment No. 151.

Amendment No. 25, in clause 14, in page 11, line 24, at end insert—
'() Subsection (2) applies in relation to a Council as it applies in relation to its member Forums.'.

Amendment No. 26, in clause 14, in page 11, line 36, at end insert—

'() The regulations must include provision as to the use by member Forums of a Council, and by the Council, of shared facilities and staff.'.

Amendment No. 6, in page 12, line 7, leave out clause 15.

Amendment No. 19, in page 12, line 34, leave out clause 16.

Government amendment No. 159.

Dr. Fox: This is likely to be the most controversial of the debates today. The strength of feeling aroused must have come as a shock to the Government; it must have come as a lesson to them that, although they may be able to muzzle criticism inside the How e, it is much more difficult for them to do so in the real 'world. We look forward to whatever climbdown from the proposals the Minister of State is going to make.
Under the Government's proposals, the current functions of community health councils will be divided up into patient advocacy and liaison services, patients forums and local authority scrutiny committees. During the debates in Standing Committee, the Government did nothing to dispel our fear that the replacement of CHCs with a fragmented system will mean that there will no longer be an overall body that can span many care providers to oversee the whole of a patient's experience. The example was used of a patient who, in a single episode of illness, had a problem with his GP, a problem with the ambulance service and a problem with the acute trust. Under the new system, to whom would such a patient complain about each of those bodies? Will the patient find the new system more difficult or easier than the current one?
Similarly, the separation of scrutiny and complaints procedures undermines the work of CHCs in understanding the broader patterns of health provision. The Government have tried to argue that bringing scrutiny closer to trusts will mean that there will be speedier action. However, the loss of an independent perspective may result in no action at all. Attempts to solve those problems will necessitate further quangos. The new clauses proposed by the hon. Member for Wakefield (Mr. Hinchliffe) would create even more confusion. The Government are creating a system in which patients will have to shop around for their rights.
I am sorry that no apology was offered in Committee for the way in which CHCs have been treated by the Government during the progress of this matter. The Government have still to apologise for the lack of consultation that has left their employees in the dark as to the future. In the House, the Prime Minister famously claimed to have consulted the CHCs, but they denied it and the right hon. Gentleman was forced to backtrack. As Richard Gordon QC told the Association of Community Health Councils for England and Wales:
in my opinion, the consultation process Dyer the new NHS plan was…legally flawed.
That is a severe indictment of Ministers. What was the ministerial response? In a letter, the Under-Secretary, the hon. Member for Birmingham, Edgbaston (Ms Stuart), who is not in the Chamber at present, replied:
We do not accept that the Association of Community Health Councils for England and Wales or CHCs had any legitimate expectation to be consulted in relation to the proposals that CHCs should be abolished in primary legislation to be introduced in parliament in due course.
So, the association was felt not to have "any legitimate expectation"—yet the Prime Minister went to great lengths to point out how extensively the Government were consulting over the proposal. The Minister let the cat out

of the bag: the Government never believed that there was any legitimate expectation that CHCs would be consulted. That is the definitive version of the Government's policy.

Mr. Fabricant: My hon. Friend says that the Government saw no reason to expect the CHCs to wish to consult. I suspect that he will not be surprised to learn that I received a letter from the South East Staffordshire community health council that states
the Government has consistently refused to consult on this issue, and has still not produced substantive detail on our proposed replacements, even at Committee Stage.
In a short intervention, I might just go on to say—

Mr. Deputy Speaker: Order. I think perhaps the hon. Gentleman might not go on to say anything.

Dr. Fox: My hon. Friend the Member for Lichfield (Mr. Fabricant) is right—the House will not be shocked to learn that I am not surprised at the information that he imparts.
In Committee, the Government also failed to answer some of the questions on funding in respect of CHCs. Will the Minister tell us whether the Government continue to reject the claims of the association that, by 2004–05, the new bodies that are to replace CHCs will cost £114 million, compared with the current CHC budget of £23 million? If the Government reject those sums, will the Minister tell us how they expect hospitals to fund the additional bodies?
On Second Reading and in Committee, the Government argued that the presence of patient advocacy and liaison services in hospitals will lend more immediacy to the complaints of patients. However, to steer patients towards the complaints system where necessary is greatly different from the proactive advocacy role currently played by CHCs. Independence will undoubtedly be lost, not gained—to the detriment of patient care.
The Government have also tried to argue that patients forums will be able to remove PALS from the control of trusts. That just might prevent a gross distortion of the system, but it would do nothing to stop PALS employees from feeling beholden to trusts; they might take decisions different from those that they would have taken had they enjoyed full independence.
The Government have failed to explain how conflicts of interest on the part of councillors scrutinising care trusts will be dealt with. Such conflicts will arise when councillors are increasingly called on to scrutinise services for whose funding and provision their authority has joint responsibility. They will thus not be independent of the services that they scrutinise. Many such councillors will be of the same political persuasion as the non-executive directors, and even chairmen, of the local trusts. We do not need to go back over the ground about appointments to trusts under the Labour Government-of which Dame Rennie Fritchie gave such a damning indictment. An alternative scenario might pertain, in which such councillors were of a different political colour. What we would then see would not be cronyism but the use of the situation as a political football, in a way that does not occur at present. That cannot be to the advantage of patients.
The Government have been unable to confirm that the lone member of the patients forum appointed to a hospital trust board will be selected by the relevant patients forum.
Perhaps the Minister can offer us that assurance tonight. In a Labour party briefing, the Government have also tried to portray patients forums as mini-CHCs. This is the line that goes out: "Don't worry about it because the patients forums are really mini-CHCs". If that is so, why are the Government abolishing CHCs? That makes no sense whatever.
In Committee, the Minister of State said:
It is our expectation, however, that patients forums will undertake specific or general monitoring activity. That is important as an allegation has been made—and repeated this morning—that the aim of the exercise has been to remove from the system of scrutiny in the NHS any organisation or body that could play that role. That is not the case. Patients forums will be able to carry out that role, as CHCs have in the past."—[Official Report, Standing Committee E, 30 January 2001; c. 235.]
If all that the Minister said in Committee is true, why do the Government want to abolish CHCs, which are currently performing those tasks, in many cases—as the Minister pointed out—excellently?
Ministers have conspicuously avoided public discussion of these issues. The Association of Community Health Councils for England and Wales held a seminar on 4 December last year, but the Minister who was to respond wrote in advance that she would be unable to answer questions about the Government's proposals to abolish CHCs. In other words, the Minister with responsibility for the abolition of CHCs tells a conference of CHCs that she is unable to answer questions on that very issue.
The Department of Health arranged a meeting in Fulham on a day when the Standing Committee was discussing many of those issues. A junior Minister took the place of the Secretary of State, but there was no sign of the promised guidelines. That is not surprising, given the confusing signals coming from the Government.
As we noted in Committee, the Prime Minister's agent wrote to his local CHC in Durham to say that, on the anniversary,
Tony would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future.
The Prime Minister's implementation of the concept of "every success" is the success we wish for the Government in the coming general election. A short time after that letter, the Government announced the abolition of CHCs. Indeed, on 4 December, the South Durham and Weardale CHC, which covers the Prime Minister's constituency, wrote:
We are concerned that the Government have announced the intention to abolish CHCs as a cynical attempt to silence any negative publicity…What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS.
Interestingly, neither the Labour-dominated Scottish Executive nor the Labour-dominated Welsh Assembly has made any plans to abolish CHCs. What have patients in England done to deserve such special silencing treatment from the Government?

Mr. Peter Bottomley: My hon. Friend has quoted the Prime Minister's agent wishing CHCs well in the future and cited the Prime Minister saying on the Floor of the House that there had been

consultation on their abolition. Has any Minister from Department of Health acknowledged on the Floor of the House that there has been no consultation? If no Minister has yet done so, will the Secretary of State do so now?

Dr. Fox: I very much look forward to Ministers being open about the fact that there was absolutely no consultation on the abolition of CHCs, either before it was announced in the national plan or subsequently. They have consulted only on what should replace CHCs. To suggest that proper consultation on abolition has taken place is to define the concept in a way that the rest of us would not understand from reading an English dictionary. That shows that the Government's interpretation of consultation is very far removed from that which anyone else would regard as meaningful.
Under new clause 10, tabled by the hon. Member for Wakefield, CHCs would not be retained, and we simply cannot accept the complex mechanism that he proposes as an alternative. What has been suggested in that new clause constitutes a tool for limiting the damage that the Government's proposals would cause, rather than an attempt to stop the damage being done in the first place. I am sorry that the hon. Gentleman has departed from his position, which involved a robust defence of CHCs; he is now trying to ameliorate the damage. That is a case of crusader turned collaborator, and it does the hon. Gentleman no justice.

Mr. Fabricant: Will my hon. Friend give way?

Dr. Fox: I will not. I hope my hon. Friend will forgive me.
We make a strong case in new clause 2 for reforming CHCs to make them more effective. For example, there could be more standardisation of CHC work, reform of the appointments systems and better resourcing. No one can deny that CHCs have done good work-for example, in the Harold Shipman and Rodney Ledward cases, in preparing and publishing "Casualty Watch" and in highlighting the many instances of poor performance in our hospitals. It should never be forgotten that CHCs represent the entire public, not just patients in the NHS. There is a growing feeling among politicians, CHCs and patient and medical bodies that Ministers are making up all the new systems as they go along. No doubt, they will make up a new version on the hoof during the debate.
Some CHCs do work well, and we all accept that. Ministers have said that some are excellent, and we also all accept that. Our logic suggests that we should bring the standard of the poorest up to the standard of the best. The Government's logic suggests that everyone should be judged by the standard of the poorest—then let them be abolished. I should love to see them try to apply that Mandelson test to Ministers.
The Opposition will accept nothing less than reform and retention of CHCs. If we are defeated on new clause 2 tonight, we shall carry the fight to the other place. The Government are running out of time as they come to a general election. We look forward to carrying into the general election our proposal to maintain and reform CHCs, whereas th,3 Government want to abolish organisations run by many people who have not only done sterling public service in the past and helped many patients, but who support their own party. Government


Back Benchers should be warned that if they vote to abolish CHCs, they will inflict deep hurt on many people who may well have been willing to help them in the forthcoming general election. Given that the Government have treated CHCs with contempt by failing to consult, and given that they are now treating them with disdain, Labour Members may not receive that help in the future.

Mr. Paul Burstow: The Liberal Democrats want to make it clear that we stand on a ticket of reforming CHCs, not of abolishing them. I want to outline our views on the amendments that my hon. Friends and I have tabled. I want to make it clear that if a Division takes place on new clause 2, we will join the official Opposition in the Lobby to advocate the case for retaining CHCs and building on what is good about them, not throwing out the baby with the bath water as is proposed at the moment. We belive that an effective watchdog is needed, so we must look at the good practice that exists in CHCs, which Ministers acknowledged in Committee.
7.45 pm
The new arrangements will fragment the watchdog rule. They will shatter the complaints handling system and inspection and overview. They will scatter those matters around to a range of new bodies. The new system—which is being gradually revealed, piece by piece—is more centred on the interests and needs of care providers than on those of the patients who receive that care. The reality is that people's experience of the NHS is gained not on a piecemeal basis of what individual trusts provide, but on the care pathway that they take through the NHS, which includes visits to their GPs and the services provided by community NHS trusts and acute trusts. To end up with a system in which different patient, forums deal with different aspects of patients experience misses the point of trying to create a patient-centred NHS. That is what the Government say in their NHS plan they want to do, but the new system will not deliver it in practice.
As the hon. Member for Woodspring (Dr. Fox) has said, the new arrangements will leave community interests out in the cold. We are specifically sealing with patients experience of the services provided, so it is essential that we do not lose the wider view of the interests of the local community being served by the local health care economy, the NHS and other care providers. The powers and other aspects of the proposals show. time and again, the confusion between customer care and advocacy on behalf of patients and the community and the effective oversight and scrutiny of the NHS.

Mr. Gordon Marsden: I think we would all applaud what the hon. Gentleman says about the needs of the community, but does he not accept that the role of the proposed patient advocacy and liaison service is an entirely new one, especially for patients in hospital, which is not currently addressed by CHCs?

Mr. Burstow: The hon. Gentleman is right to say that the role of PALS is entirely new, but it is a customer-care role, not a customer advocacy role. Indeed, the Bill contains no specific proposals about setting up independent advocacy services. New clause 10, tabled by the hon. Member for Wakefield (Mr. Hinchliffe), tries to

deal with that, and the hon. Gentleman has our support in that respect because proposals that establish genuine, independent advocacy services for patients are needed.

Dr. Fox: Does the hon. Gentleman accept that even if we accepted that PALS were good in itself, there would be nothing to stop that being introduced alongside CHCs, as an additional measure rather than as a substitute?

Mr. Burstow: I entirely agree. The proposals on PALS should be viewed completely outwith those on patient advocacy and the ability to scrutinise how the NHS works on behalf of local community and patients. PALS are separate matter, but the proposals, although useful, are more about customer service than about anything else. Although PALS are a good idea, we do not view them as part of the watchdog role that we need to retain and develop. Many outside the House, including many of those who lobbied hon. Members today, view PALS as poodles rather than effective watchdogs.

Dr. Brand: Does my hon. Friend agree that the real value of PALS is to encourage the internal resolution of complaints in trusts and that they will be very useful vehicles for doing just that, but that they cannot be a substitute for supporting people who have genuine problems with the care provided by trusts and who have lost faith in them?

Mr. Burstow: My hon. Friend is absolutely right. It is worth stating that the Government still have to produce the details of the complaints procedures. They are designing the systems to operate a new complaints procedure before we have seen them. They are putting the cart before the horse.
The overview role, which is to pass to local authorities, will be handicapped if we do not have the benefit of the insight provided by inspection and individual complaints. The independent local advisory forums that health authorities will set up are neither independent nor particularly local—and, not least, they lack statutory backing. As a result, they will be the creatures of the Secretary of State. I hope that they will be independent, but they will be very much at the beck and call of individual Secretaries of State in terms of the directions that will be used to set them up.
The Government have so far failed to make the case for abolition. The CHCs, as they stand, are underpowered and under-resourced. As has been said in this debate and in Committee, their performance is variable across the country. However, surely we should raise the standards of the poorest performers to match those of the best. We should examine what is good in the system and build on that instead of casting the whole system aside. The Government's reasons do not sustain the case for abolition; they are reasons for reform and for properly resourcing CHCs, not for getting rid of them.
If we are unable to persuade the Government tonight of the merits of new clauses 7 and 8, my colleagues will not accept the case for abolition when the Bill is considered in the other place. They will not vote for abolition and will want the Government to embrace the case for reform before they accept any attempt to take the Bill through the Lords. To that extent, we welcome the fact that Members in both Opposition parties support that approach.
The Government have failed to make their case. In Committee, several Labour Members told us that CHCs had not fulfilled their role as the bodies that deal with complaints in the NHS. Unfortunately, that is a bit of misconception. Although CHCs undertake complaints on behalf of complainants and help them navigate their way through the complaints system, there is no statutory duty on them to do such work. Despite the fact that no funds had been specifically earmarked for that purpose, CHCs saw a gap, recognised a need and undertook that responsibility and it is only because of that that they carry out the role at all. That is another reason for considering how we can ensure that they are properly equipped. We should pay tribute to the work that CHCs have carried out, for example, in the Alder Hey case. The work that they did in supporting parents should not be neglected when we consider the case for keeping them.
Our new clauses 7 and 8 show how CHCs could be reformed to become the delivery mechanisms for the proposals set out in the NHS plan. The new clauses address the need for independence and co-ordination. They are about stitching together the pieces in the NHS plan and in the scheme for consultation and the empowerment of patients. Quite rightly, they would extend the remit to primary care and they would locate the independent advocacy services in the new reformed CHCs. They would establish patients forums as sub-committees of CHCs and allow co-ordination, sharing and the following of patients care pathways to take place more effectively. They would also require the Secretary of State to consult on the detail.
I do not believe that the Government have demonstrated that their proposals, as they currently stand in their various pieces, will enhance the patients voice. New clause 9, which was tabled by the hon. Member for Wakefield, will not do that, either. It does not go far enough. Although I understand the intentions behind it, it fails to deal with the fragmentation of the proposals in the Bill and in the NHS plan. It would add an extra tier without being clear as to what that tier would do for the management of patient advocacy.
The Government have overlooked the wider community, but one of the questions that has been asked tonight and in Committee is how much their proposals will cost. When the Bill was in Committee, I tabled a written question to ascertain from the Government how much the proposals would cost and I received a reply from a Minister telling me that it would not be appropriate to provide that information because we were not at the right stage of the Bill's passage through the House. Does that mean that there can be no scrutiny of the Government's proposals for the abolition of CHCs and their replacement, or does it mean that scrutiny must occur once the Bill has become an Act and the details have been worked out in regulations? What on earth does it mean when a Minister tells the House in a written answer that it is inappropriate to provide the costings that should be the basis of examination, scrutiny and debate in this place?
The proposals in the Bill were unmodified in Committee and I suspect will remain unmodified after the Report stage. The arrangements are nothing more than a dog's breakfast. We need a decent watchdog on behalf of patients and the wider community, and unless we get that, we will not accept this part of the Bill.

Mr. David Hinchliffe: I wish to speak to the new clauses that stand in my name and in those of my hon. Friends.
I have listened with interest to the two previous contributions, and he hon. Member for Woodspring (Dr. Fox) appears to think that I have performed a U-turn. He must have been absent when I spoke on Second Reading. I said that I had been a member of a CHC for 10 years and served as its vice-chair, but added:
I hold no particular brief for community health councils…Some are excellent, but some have not done the job required of them, and the voice of patients has not been heard. Such CHCs have been the poodles of local trusts and health authorities. They have not stood up to be counted on occasions when patients' views should have been expressed loudly and clearly at local level."—[Official Report, 10 January 2001; Vol. 360, c. 1106.]
That comment was not reflected in what the hon. Member for Woodspring said about my personal position.
On Second Reading, I said—and I repeat it tonight—that the provisions in the Bill, as it stands, do not offer a better alternative to tie C'HC system, and I tabled my new clauses in the hope that we could improve the Bill in a constructive fashion.

Mr. Fabricant: The hon. Gentleman has suggested that there is nothing in the Bill that would make CHCs better. Does he agree with me and other Opposition Members, including those in the Liberal Democrat party, that the Bill will make the position worse?

Mr. Hinchliffe: There are positive aspects in the Bill that I wish to mention, but I think that we can improve it. I hope that by the end of the debate we shall have a new structure that will represent patients' interests in a more effective way.
As I argued a moment ago—and as I argued on Second Reading—the effectiveness of CHCs varies considerably. Every hon. Member knows that. Some are excellent, but some are anonymous and some are invisible. I picked up that point when the Select Committee on Health conducted a major inquiry into adverse incidents and considered some serious problems. I asked several patients who had been affected—in some instances they had lost relatives—and some of them had never even heard of the local CM. We must address that point.
In other areas—the Alder Hey case is a positive example—CHCs have played an important role and there is a different picture We need to get consistency, and I hope that my new clauses will introduce a degree of consistency.

Dr. Fox: The hon. Gentleman has said, as the Minister has said before, that some CHCs are excellent—so is not the logic to bring the standards of the poorest up to the standards of the best, if necessary by plugging the gaps that the hon. Gentleman mentioned by introducing services such as patients advocacy and liaison services? Would that not be better than going down the route of abolition, and introducing other bodies to ameliorate the damage, as is suggested in his new clauses 9 and 10?

Mr. Hinchliffe: I hope that the new system will build on the excellence of some CHCs. That is precisely what


I want to see the new clauses achieve. [Interruption.] If Conservative Members listen, I shall explain what the new clauses mean.
On Second Reading, I made the point that, arising from the work that the Health Committee did on the scrutiny of complaints in our adverse incidents inquiry, we picked up directly from patients the clear principle that they wanted to be included in any changed system. I mentioned the details on Second Reading, and I shall not repeat them now. However, the two key area; that patients were concerned about were independence and having a comprehensive system.
My concern about the Bill echoes one or two of the points that have been made in the two previous speeches. The PALS—patient advocacy and liaison services—system is, indeed, trust based. It focuses on the work of a single trust, be that a hospital or i primary care trust. Therefore it is neither independent nor comprehensive. However, I have no problem with a system that offers an effective customer services department in my local hospital or my local primary care trust where I, as a patient, can go to resolve issues face to face with the trust. As I understand it, that is the purpose of PALS, so I am happy for that system, as proposed in the Bill, to remain.
The concern that I raised on Second Reading about patient advocates was that the Bill was not explicit about the location of the advocacy function. We were initially advised that that function might be commissioned by health authorities. I was worried about that because I have dealt with complaints that relate to health authorities. It struck me as wrong that any system that purports to be independent could be funded by a party to a complaint, that is involved in the problem. It was suggested that we might locate advocates within the remit of the local authority scrutiny panels, but those panels will be scrutinising the work of the new care trusts.

8 pm

Dr. Brand: The hon. Gentleman knows that I have much respect for his views. Is he riot surprised that we are being asked to decide on the Bill tonight, before we know of the outcome of the Government's review of the complaints system? Perhaps he has greater knowledge of what is in the minds of Ministers, put is he not alarmed that we are being invited to adopt a framework without knowing what it has to deliver?

Mr. Hinchliffe: If the hon. Gentleman reads my speech on Second Reading, he will see mat I referred to that matter. However, the principles that we can establish tonight will relate to the review's conclusions.
The Bill also provides for the patients forums. I am concerned that the new arrangements will focus primarily on one aspect of the system and will not enable a complaint or problem to be considered comprehensively. We all know that the patient's pathway through health care often starts in primary can, and moves on to secondary and tertiary care before going back into the community. The system needs to reflect the need to look across the board at the comprehensive issues that affect patients when they have a complaint.
I want to thank a number of people who have been involved in many discussions with me and others in the past few days and during the Committee's proceedings. The Clerk was extremely helpful, because he attempted to


pick up on some of our concerns. I am also grateful to the Association of Community Health Councils for England and Wales and, in particular, Donna Covey. The hon. Member for Woodspring said that I had sold out on CHCs, but I was with Donna Covey immediately before I tabled my new clauses and amendments on Monday, and she did not give me that impression—nor do representatives from my local CHC, who have been here today. They recognise that we are proposing a positive way forward, on which we can build.

Dr. Stoate: My hon. Friend knows that I support what he is trying to do. I met my CHC earlier today and its members, too, were happy with the new clauses and amendments. They believe that they will strengthen the position of CHCs rather than make it worse. I urge the Minister to accept my hon. Friend's new clauses and amendments.

Mr. Hinchliffe: I am grateful for my hon. Friend's support. The new clauses and amendments have drawn a wide range of support from Labour Members, and have also received positive comments from the Opposition. I am proud to have got both my hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) and my right hon. Friend the Member for Chesterfield (Mr. Benn) to support the same new clause. That is quite an achievement—I think I have discovered the third way.
I pay tribute to my right hon. Friends the Minister of State and the Secretary of State for the work that they have done on this issue in the past few weeks and today. They have taken the concerns that we have expressed seriously, and listened to them.
Let me explain my proposals, because Conservative Members obviously do not understand them. I am suggesting that the PALS system should remain. The customer services role is valid and reasonable. It will be genuinely helpful in resolving many—possibly most—of the issues that affect patients in local hospitals and local primary care trusts. I have also included patients forums in new clause 9, because it is logical for them to be closely involved in considering the detail of individual trusts at a local level.
The hon. Member for Sutton and Cheam (Mr. Burstow) said that I would introduce an extra tier. I am probably more intimate with the detail of his new clause than he is—he knows the background to that, and I do not wish to embarrass him. There would be no extra tier. Instead, my proposed arrangements would occupy the same tier as the CHC would represent in his new clause on the retention of CHCs. I want patients councils to be established as umbrella bodies that will collectively draw together the individual patients forums to address the issue that worries me—the lack of a comprehensive overview of the work of the trusts. That function will create a better system.
I am proposing to establish a common secretariat to service the individual forums and the patients councils. The councils functions would not be dissimilar to those discharged by CHCs. However, the significant change, which reflects the Select Committee's views on advocacy, is that they would, in most instances, host the independent advocacy services set out in new clause 10. The hon. Member for Sutton and Cheam is wrong to say that CHCs already have that advocacy function, because many


do not. A major weakness of the health service, which the Committee has noticed several times, is the lack of advocacy services.
In my dialogue with the Government, I have recognised that basing advocacy services within every patients council may not be the most appropriate arrangement. There are geographic differences in the areas to be covered. I believe that patients councils should be consulted by the Secretary of State, in accordance with new clause 10, about where the advocacy function should be placed.

Mr. Simon Thomas: I thank the hon. Gentleman for explaining his proposals so carefully. Will he elucidate a little further on how they will affect CHCs in Wales? Wales is covered by new clause 10, but CHCs are to be retained in Wales—[HON. MEMBERS: "You support that."] Indeed, I do, but surely it would be better for the Government to go back to the drawing board, forget about their current proposals and return to the House with fresh suggestions.

Mr. Hinchliffe: I support devolution and believe that if the Welsh wish to retain CHCs they should have that right. I look forward to a time when there is devolution in Yorkshire, and I no longer have to mix with some of the people that I meet here.

Dr. Lynne Jones: Representatives from my local CHC told me today that they were concerned about how representatives on patients forums and patients councils might be appointed. Does my hon. Friend agree that great care will need to be taken to ensure that representatives are genuinely independent? That might be easier with trusts that have an on-going relationship with patients—such as mental health trusts—than acute trusts, where patients are often involved with the hospital only for a short time.

Mr. Hinchliffe: My hon. Friend will understand that I have not proposed to amend the Bill as it relates to the new NHS Appointments Commission, which was established after the publication of Rennie Fritchie's report. I accept that the issue needs to be considered carefully, and I make no bones about the fact that I am proposing a framework that needs to be examined in more detail.
New clause 10 is especially important. The Select Committee noticed—

Mr. Mark Todd: Will my hon. Friend give way?

Mr. Hinchliffe: No, I am sorry but I must conclude; I have given way several times.
The Select Committee picked up on patients concerns that when something has gone badly wrong in the NHS—fortunately, that does not happen very often—the experience has been worsened by the inability to get an appropriate response, help in complaining, and someone to rectify the damage. I hope that the advocacy services as proposed in new clause 10 would help to deal with that.
My proposals wilt improve the system proposed in the Bill. Patients councils will be independent and comprehensive. They will bring together the various patients forums. They will cover primary care. Community health councils do not co that, which is a huge weakness. I am surprised that those who are defending the status QUO do not recognise that. Moving to the idea of patients councils reflects the work that they will do better than does the term "community health council".
In my constituency—as in the constituencies of some of my hon. Friends, perhaps—there is a community health trust. I would bet that 99 per cent. of my constituents have not the least idea about the difference between the community health council and the trust. I hope that the name "patients council", which will reflect so much of the positive contributions of the CHCs, will have an impact.

Dr. Fox: Will the hon. Gentleman give way?

Mr. Hinchliffe: No.
I accept that the new clause and the amendments should be reconsidered in another place. However, I hope that we have a framework on which we can build. We must consider continuity between any change and the new system. I genuinely hope that some of those who have served so well on CHCs will make a major contribution within the new system. My proposals offer a framework for improving patient representation. I hope that the Government will accept them. If not, I intend to put the issue to the vote.

Mr. John Wilkinson: The debate characterises all that is worst about the Government, and particularly their management of the national health service. Earlier, we had the disgraceful spectacle of the Prime Minister refusing to admit how many people had written to him in support of his proposals to abolish community health councils. He did not have the courage or the candour to recognise that it was only a handful of people, or none. We know that there have been numerous representations in favour of the retention of CHCs. They have been articulate and well argued. I have received no representations in favour of the proposal to abolish them, as announced in the NHS White Paper.
That was typical of the Government. There was a fanfare of political trumpets in favour of the proposals in the White Paper for increased resources for cardiac care and thoracic medicine, for example. However, in the small print it was seen that the CHCs were to be abolished. People realised that yet again they had been conned. They were unimpressed and, as a consequence, opposition to the proposals to abolish CHCs grew to the point where Parliament was lobbied by many people this afternoon. I am talking of individuals who have given many years of service, dedication and professional expertise to helping to resolve patients' complaints and representing the interests of their local communities through the health service.
The hon. Member for Sutton and Cheam (Mr. Burstow) was right to stress the importance of the representational role of local communities, which CHCs fulfil. It is the arrogant and soviet-style management of the NHS which is so abhorrent to n any of our electors. There is the feeling that decisions are taken on high in Whitehall that


have no relationship to the situation in particular community areas. CHCs fulfil a crucial lightning-conductor role in trying to dissipate the feeling of impotence, fury and frustration within many local communities against decisions that they believe to be entirely wrongheaded and against their interests.

Mr. Hilton Dawson: Will the hon. Gentleman give way?

Mr. Wilkinson: No, I will not. I w ill amplify my point.
In the part of Middlesex that I represent, proposals have been imposed by the Government to move one of the best burns and plastic surgery units in the country from its present location at Mount Vernon hospital. To its credit, the CHC provided the impartial chairmanship of consultation meetings. It answered the questions and it sought to resolve the difficulties. Above all, it provided a mechanism, as it has for the proposed closure of Harefield hospital, for objections to be lodged with the Secretary of State, upon which he will have to make a decision. The crucial function of official objection is one which needs to be maintained. It gives the public at least some hope that they have an opportunity of redress against wrongheaded public policy.
8.15 pm
The hon. Member for Wakefield (Mr. Hinchliffe) gave me the impression, with all his bluster, that he had been bought off politically. New clauses 9 and 10 may be verbose but they are not clear. Patients councils, which he is advocating, seem to offer a bureaucracy which gullible people might believe to be a genuine alternative to an effective system provided by CHCs, in which the public already have great confidence.

Mr. Hinchliffe: Will the hon. Gentleman explain the difference between what I have proposed and existing CHCs that have sub-committees? The only difference, as I see it, is independent advocacy and the title.

Mr. Wilkinson: I leave that judgment to the Secretary of State. If he and his Department are impressed with the proposals of the hon. Gentleman and his numerous friends who have similarly been bought off, the right hon. Gentleman will show himself to be more amenable to rational argument than he has in most of his direction of the NHS. I shall applaud the event. I am sure that some Labour Members will, too. However, I do not believe that it will happen, any more than I believe that I shall see pigs airborne tonight.
We have heard about local government being a forum within which complaints can be addressed. Usually, local people fail to regard local authorities as impartial. Instead, they regard them as party political institutions. Local government is not genuinely objective. The joint responsibility that it has with the NHS in the social services sector gives it a vested interest that CHCs do not possess.
We have heard, too, about the patient advocacy service. If patients are to have confidence and feel that their complaints are properly addressed, NHS hospitals need a clear line of command. There should be one chief executive, to whom complaints shot Id be addressed. He should address them properly, answer them and meet any

failings in the service with the necessary changes, and, if necessary, alterations of style and method of service. However, this does not happen.
All too many hospitals have a shared boss. In the part of London that I represent, one section of Mount Vernon, a major hospital, has, in essence, a head who is the boss of three other hospitals. How will that give confidence to patients? How does it give staff the authority to know to whom they should refer? It is a recipe for chaos. That is why even a patients advocacy service in a hospital is not the right mechanism. One wants a clear line of command, and the man or woman in charge at the top to take full responsibility for everything that goes on in the institution.

Mr. John Hayes: Does not the difference between existing practice and that advocated by Government Members as a replacement centre on the fact that the existing system is well tried and tested, well understood by many people and involves many good people who are already giving service? If it is working, why change it? If it ain't broke, why fix it? Is that not the difference between what my hon. Friend is proposing and what was proposed by Government Members?

Mr. Wilkinson: As so often, my hon. Friend is right, and he makes his point succinctly and clearly. I suspect that there is a malign motive: CHCs, by and large, do their job so well that they show up the deficiencies of the NHS and reflect the foolishness of many public policy decisions taken by the Government.

Mr. Dawson: rose—

Mr. Wilkinson: I shall now give way to the hon. Member for Lancaster and Wyre (Mr. Dawson); I accept that I ought to have given way to him earlier.

Mr. Dawson: Does the hon. Gentleman accept that CHCs are not powerful enough? They often end up making their point by shouting from the sidelines. Does he further accept that putting a representative from a patients forum on the board of every trust undermines all the pejorative remarks that he has made about the new system of representation?

Mr. Wilkinson: The hon. Gentleman makes an extremely wise point, with which I have considerable sympathy. If he studied new clause 2, he would see that we propose that there should be 12 months from the enactment of the Bill for the Secretary of State to consider appropriate reform of CHCs. The Secretary of State would have time to get it right. The Government bounced abolition of CHCs on an unwitting public, with no consultation or prior notice.
Under subsection 4 of the new clause, the Secretary of State would be bound to
provide for the proper representation of the population".
It is therefore essential that he appoints individuals with qualifications, impartiality and commitment to public service, which are all attributes that would give confidence to local communities and those whom they would represent. Last but not least, Parliament itself


would have to consider whether proposed reform was wise. We would have to judge it, with debate on a statutory instrument giving effect to the proposed reform.
To conclude, the hon. Member for Lancaster and Wyre suggested that the CHCs were not powerful enough. As I said, I am sympathetic to that view. However, the problem also lies with Whitehall and Secretaries of State who believe that they know best. The official objections lodged against proposed changes to the NHS—such as the closure of Harefield hospital, to which my local CHC, along with Brent and Harrow, have lodged official objections-should be taken seriously by the Secretary of State and acted upon through modifications of policy and changes to bring public policy into line with the wishes of local communities. Because the Government seek to impose their will, Soviet—style, on local communities, there is frustration and a feeling of impotence, which can be best addressed by the retention of CHCs and their intelligent reform, as proposed by new clause 2 and the Opposition's related amendments.

Dr. Stoate: We have now had CHCs for about 25 years. Listening to Opposition Members, one would think that everything in the garden was rosy and that there was no cause for concern whatever. Even on the admission of Opposition Members who have spoken, the service provided by CHCs is at best patchy. There are some excellent ones: the CHC serving Dartford and Gravesham is a good one, and I have an excellent relationship with it. I have been a doctor for a long time and, time and again, I hear of cases in which CHCs have failed patients or been unable to help them in the required way. I shall give some examples.
CHCs have no role in primary care. Opposition Members talk about CHCs as if they were wonderful. However, although the Tories were in power for 18 years, they never addressed the fact that CHCs have no role at all in primary care. My practice is immune to CHC interference, which is illogical. If everything was so wonderful, why is performance so patchy, why do CHCs have no role in primary care and why are they unable to investigate when primary care services fail or when premises are substandard and patients consequently get a bad deal? That is an illogical situation.
There is no consistent advocacy role across the country. Some CHCs, including my own, provide an advocacy service. Others, however, do not. There is no requirement for them to do so, so patients in some parts of the country have no access to advocacy. If CHCs were uniformly wonderful, surely that sort of thing would be provided by all CHCs? Given that the Opposition were in power so long and did not address those issues, one wonders what was their understanding of what was going on in the community and the health service.

Mr. Burstow: Does the hon. Gentleman accept that he is making a case for reform to drive up standards to the best standard? Has he considered new clause 7, which my hon. Friends and I tabled, which specifically extends the role of CHCs to cover primary care and deal with advocacy?

Dr. Stoate: The hon. Gentleman makes valid points, and I agree with some of them. However, the bottom line

is that doing nothing is not an option. For far too long, CHCs have provided a complacent service in some parts of the country, which has not worked. We need radical reform; how that reform is carried out is a subject for debate, and which proposals we accept are a legitimate concern for the House.
Making the advocacy service uniform across the country is the right way forward. Patient advocacy and liaison services, which will provide a point of contact in every hospital, are the right way forward. If wards are dirty or showers are not working, there will be somebody on site who can call the management to account then and there. Recently, the House heard how the mortuary in Bedford hospital had rusty hinges on its doors. PALS could pick up and sort out that kind of thing, avoiding some of the tragedies that have occurred. We have to have that radical reform.
It is equally important that we make sure that patients feel as if they are at the center of the NHS. Although it is important that patients get a good deal, it is also important that they feel they are getting a good deal. In too many parts of the country, they do not feel that. The Government's proposals on patients forums go a long way towards dealing with that. However, there is clearly a problem.
Some patients and some people in the community feel that patients forums might be too close to the health authority, the trust or the local authority. The umbrella organisation—the patients council—suggested by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) is surely the way forward. That could give a sense of overriding impartiality and independence, and would encompass all the reforms under one umbrella.
When I discussed the idea with members of my CHC earlier today, they were reassured by the proposal and think that it would go a long way towards addressing their legitimate concerns. I do not want to belittle CHCs. They have done a marvellous job, they are a well-intentioned group and they include some excellent people, but the service is not uniform. For far too long, patients have been sold short because they have not received the uniform, guaranteed level of service that they have a right to expect in the 21st century.
Opposition Members tell us that everything in the garden is rosy, when clearly it is not. They failed to address the problems for 18 years. [Interruption.] I do not mean the Liberal Democrats; I am referring to the previous Government. I believe that the Liberal Democrats have honourable intentions on the matter and I do not dismiss what they say. I do not believe that they have the right ideas, but I do not belittle what they do.

Mr. Gordon Marsden: Does my hon. Friend agree that it is the height of hypocrisy for the Conservatives to complain about postcode rationing, as they do so often in their rhetoric, when they are prepared to continue the system of community health councils which leads to that?

Dr. Stoate: My hon. Friend makes an excellent point. Effectively, there is postcode rationing through CHCs. There are excellent ones in some parts of the country, and others that are unacceptably poor. My hon. Friend the Member for Wakefield and I are asking the Government to consider how we could get the best of all worlds—


a truly uniform service under the umbrella of patients councils, which will ensure that patients get a good deal, wherever they live.

Mr. Fabricant: I have been listening to the hon. Gentleman's rant, but he clearly has not read new clause 2. The Opposition recognise that everything in the garden is not rosy, despite what the hon. Gentleman says. That is why we propose in new clause 2 that there should be reform. He proposes throwing the baby out with the bath water.

Dr. Stoate: The hon. Gentleman I as not been listening. That is precisely what I suggest we should not do. His party was in government for 18 years, and has finally come round to the idea that there ought to be reform. That is laughable. The Conservatives had a long time in which to do something, yet they did nothing. We are proposing radical reform and, more important, reform that brings benefits to patients, uniformity of service, an advocacy role and the guaranteed impartiality of the umbrella suggested by my hon. Friend the Member for Wakefield, which I hope Ministers will accept.

Mr. Stephen O'Brien: Let us start at the beginning and not lose sight of tow the issue arose; perhaps then it would be proper to ask about the motivation behind the Government's summary decision to scrap community health councils.
There was a consultation exercise on the NHS, which was not well responded to. It is nimoured—we do not have the findings—that the few respondents who referred to CHCs generally did not know much about them. Let us consider why that might be. Although they were not originally expected to deal with complaints, CHCs have grown to be the body in which patients have confidence and which they trust to deal with their complaints, because CHCs are seen to be independent.
One of the reasons for the success of CHCs is that patients, who are often vulnerable at this stage, or their relatives, have been able to engage with them in trust, because CHCs have tended not to trumpet what they do. With their knowledge, expertise and volunteer spirit, CHCs have sought to resolve problems, and only when a resolution was not possible, after exhaustive efforts, were formal procedures initiated to take a complaint forward and ensure that it was properly resolved in accordance with the patient's rights.
It is not right to think that because CHCs are not generally known, they should be abolished. Surely a Government using the rhetoric—but not the substance—of meritocracy would look at the worth of CHCs, not seek to abolish them because they were not known.
I was more hopeful about what the Chairman of the Select Committee, the hon. Member for Wakefield (Mr. Hinchliffe), would say, and I eagerly awaited his comments. I found his speech disappointing and not as dispassionate as I had hoped. It brought to mind Churchill's remark when he was told that there was a new hon. Member in the House called Mr. Bossom. He said, "Oh dear, poor man. Neither one thing, nor the other." That was very much my reaction to the speech of the Chairman of the Health Committee. It is not possible to argue for independence and at the same time to trumpet

the potential benefits of structures whose purpose is to expose the difficulties of the very institutions of which they are part.

Mr. Hinchliffe: The hon. Gentleman is arguing that the existing structure of CHCs is independent. Does he understand the current make-up of CHCs, particularly the fact that one third of their members are members of local authorities? How would they monitor independently the work of future care trusts?

Mr. O'Brien: I hope that the hon. Gentleman would be surprised if I were not aware of the make-up of CHCs, as I have made a study of the subject. The members currently nominated by local authorities are in balance with the other interested parties on CHCs. One of the difficulties with the Government's proposals is that that balance would shift towards much more political involvement at local authority level. That is an important point to recognise, even if the Chairman of the Health Committee believes that the Government are proposing something different. Like him, I have had discussions with the Association of Community Health Councils for England and Wales. It was keen to support new clauses 9 and 10, but that support was expressed before the association had seen new clause 2. Today I had a meeting with CHC representatives who were specific about the fact that they regard new clause 2 as the better option and that they would prefer it to win through on Report.
The decision to abolish CHCs appeared shortly before the summer recess, tucked away in page 95 of the Government's NHS plan, in paragraph 10.35. It was a decision, not a proposal for consultation, and it had been made without any prior consultation. The staff of Chester and Ellesmere Port CHC and of Cheshire Central CHC came to see me almost immediately. They learned through the internet of the threat to their jobs and to what they realised were regarded as voluntary organisations. That is no way for any Government to handle the morale and expertise of people who have given dedicated service and who, above all, have demonstrated that they are in it not out of careerism, but to ensure that patients get the best out of the NHS. It was a ghastly shame on the workings of the Government that they informed CHC staff through the internet that their jobs were under threat.
Of course, the decision caused massive consternation. No prior consultation had taken place. I have had regular contact with my local CHCs, which are generally acknowledged to be excellent. However, I know that strong feelings have built up not only within them, as would have been expected—the decision has also been hugely controversial among patients and NHS staff who have found CHCs to be a worthwhile and important aspect of the broad delivery of health care services.
I raised the matter in Prime Minister's questions on 15 November last year. I asked the Prime Minister whether he was aware that his proposals to scrap community health councils were bitterly opposed. He answered:
I am aware that there is bitter opposition, which is why the proposals are being consulted on.
He went on to say:
It is precisely because we want to consult that we have issued the health plan. We will report back to the House in due course on the consultation."—[Official Report, 15 November 2000; Vol. 356, c. 937.]


Surprise, surprise—I received a letter on the following Monday. It began with the words "Dear Stephen", which, surprisingly, appeared in the Prime Minister's handwriting. In the letter, the Prime Minister states:
I thought it would be helpful if I clarified the nature of the consultation on which we are currently engaged"—
in relation to the abolition of CHCs. He goes on to state:
Our proposals mean that Community Health Councils are to be abolished".
The letter continues for a further two pages, without adding anything of substance, but the Prime Minister concludes:
This better describes the consultation I alluded to in my answer during Prime Minister's Question time.
It is important to put those matters on record.
The letter, which the Prime Minister's office placed in the Library, showed that despite all the claims about prior consultation, even the Prime Minister was caught out and had to correct the direct answer that he gave to me during Question Time.
I cannot tell the House how many calls, e-mails, faxes, letters and other representations I received from CHCs and others who were concerned about the issue in the days between the Prime Minister's answer on the Floor of the House and the day I received his letter. They were delighted to see that there was a chink of light after all and that CHCs might not be abolished. However, we found a few days later, when I received the letter, that that assurance had been cynically removed. I sought to question the Secretary of State for Health the following day—21 November—but he said that he would not give an answer. In my view, that was an outrage and a gross abuse of parliamentary accountability.
I was then fortunate enough to secure a debate on the matter in Westminster Hall. The debate had an unusually high attendance, but it was notable because it was well attended not only by Opposition Members, but by Labour Members. One displayed a touch of "careerismitis" during the debate, but none spoke in favour of the Government's decision—I wish that I could say "proposals", but I cannot. We were presented with a summary decision at the end of July last year.
Second Reading and a Committee stage have occurred to no avail, despite the strength of feeling that was expressed on the subject. It is fair to put it on record that, in terms of consultation and process, the proceedings constitute a travesty and a sham. The Government should be deeply ashamed of that. They owe an apology to the hard-working staff in CHCs across the country and to the volunteers and nominees from local authorities.

Mr. Hayes: Does my hon. Friend acknowledge that the sham continued this afternoon at Prime Minister's Question Time? Although the Prime Minister knew that we were considering the Bill later, he pretended at the Dispatch Box that consultation on the abolition of CHCs, not the new arrangements, was continuing. The sham went on. We heard weasel words from the Prime Minister, and weasel words from Dr. Stoate and other Labour Members.

Mr. Deputy Speaker (Sir Alan Haselhurst)>: Order. The hon. Gentleman does not help the debate by using

those terms, and he did not observe the forms of the House in the way in which he referred to another hon. Member.

Mr. O'Brien: I noted the Prime Minister's answer, to which my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) referred quite properly. The Prime Minister attempted to paint a picture of genuine consultation. It was claimed that consultation, as it is defined in English, would take place and that people could make representations, which would be taken into account when a decision was made. We know that such consultation has not occurred. The Government have already made their decision on the abolition of CHCs. The process has been a sham. The fact that we have reached that point reflects shame on the House
My constituency of Eddisbury is in south-west Cheshire, and it is important to note that in Cheshire, where genuinely good CHCs exist, local Labour Members of Parliament have been challenged in the press to state whether they support abolishing them. Notwithstanding a hiccup from the hon. Member for City of Chester (Ms Russell), who pulled back from issuing a specific press release, nothing has been heard. No attempt has been made to justify the Government's actions.
Representatives of CHCs who came to see us today are rightly proud of their service to local patients. They are proud not only of their knowledge and independence but of their lack of careerism. The Association of Community Health Councils for England and Wales has rightly asked whether patients at e better served by lapdogs or watchdogs. The association has earned a reputation for being a watchdog.
Trust and confidence are vital. The Government have the audacity to make a distinction in Wales. As it is a properly derogated matter, it has been decided to maintain CHCs in Wales. Why should England be different? We should all question CHCs' abolition in England.
The replacements could be more costly, more complicated and less trusted by vulnerable patients who need them. Ministers have said nothing to justify abolishing CHCs, to efface the shame of their lack of prior consultation or to show that they have listened. They have had the brass neck to resist all representations, logic and the need to retain trust and confidence. Let us hope against hope that, for once, this arrogant Government will stick their brass neck out far enough to accept that they have misjudged the matter, climb down with grace and support new clause 2.

Mr. Denham: A patient-centred NHS is central to the vision that we set out in the NHS plan. Lip service has been paid for years to the idea of a patient-centred NHS, without bringing about any real change. As the NHS plan acknowledges, services are all too often not organised around the needs and lives of patients, and when things go wrong patients find inadequate safeguards and little help available to them.
During the consultation on the NHS plan, patients across the country complained that no one listened to them, that there was no one there when they needed help, and that there was no one to turn to for advice. Patients organisations stressed, throughout the consultation, that patients need to have real influence in every part of the


NHS. That is why, during our consultations on the NHS plan, we decided that there was a case for real change. The NHS plan set out radical proposals to strengthen the voice of patients in the NHS. It also sought to address the lack of democratic scrutiny at local level by involving local government elected councillors. The Bill introduces the legislative change to deliver the plan.
I want to make it clear that the starting point for the proposals was not—and still is not—the abolition of community health councils. We have designed a new system based on the need to increase and improve patient representation in the NHS. The functions of CHCs will be taken forward by new more powerful or more appropriate organisations. It is for that reason, and no other, that the plan proposed the abolition of CHCs. Some CHCs have undoubtedly done good work, given their limited structure and remit. However, that has too of ten depended on the undoubted merits of the individuals involved, rather than on the structures in which they were working. The case for radical reform has been made, and it is a case that cannot be answered with piecemeal changes.

Dr. Fox: Will the Minister answer a question that has often been asked during this debate? Was there any consultation with the CHCs about their potential abolition before the national plan was introduced?

Mr. Denham: Prior to the national plan, there was consultation with everybody who had an interest in the NHS. That included CHCs and patients. We introduced the plan in response to what patients said about what had happened to them, and about what they thought was available to them when things went wrong.
In the debate over the past few months, there have been three distinct voices. First, we heart the complacent and conservative voice of those who will not recognise the scale of the changes that need to be made if we are really going to put the patient's voice at the heart of the NHS. Those are the ones who advised us co tinker with this or that problem.
Secondly, we heard the voice of those who have suddenly discovered an interest in patents' rights that was never evident before. They are happy to jump on a bandwagon to make the Government look temporarily uncomfortable, without making a real commitment.
Thirdly, and more importantly, we have heard the constructive voice of those who have considered the Government's proposals, and asked whether the proposals are right and how they could be in 'proved. This debate has involved many people inside and outside the House, and I welcome the contributions that my hon. Friends have made tonight. We should listen to that third voice.

Mr. John Austin: I do not know whether my right hon. Friend received any Valentine cards today. I received one from some residents in Bexley, asking me to support their request for independent monitoring and independent advocacy in the national health service. Does my rid ht hon. Friend agree that the amendments tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) would give a guarantee of such provisions?

Mr. Denham: I shall come to those amendments in just a moment. The issues that my hon. Friend mentions are very important.
I shall set out briefly what we shall put in place. There will be a patient advocacy and liaison service in every trust and primary care trust. Patients want someone to sort out their problems when things first go wrong, before they need to make a formal complaint. PALS are not a replacement for CHCs because that is a role that CHCs have never played. PALS will be a powerful part of each trust, but patients forums will have the power to ensure that PALS remain influential and effective.
There will be a patients forum for each trust, monitoring its work, inspecting premises, electing a non-executive director and reporting on the quality of patient services of each trust. The patients forums will also have the power to take action if PALS fail to provide an effective service. They will have independently appointed members, representative of individual patients, patients groups and carers organisations. Establishing a patients forum for every trust and PCT is key, because that will bring the voice of the patients to bear on the individual building blocks of the NHS—that is, on each chief executive, each medical director, each nursing director, each clinical governance lead.
We have also recognised the importance of co-operation by patients forums in each local area. One of our findings from consultation and debate was the need to institutionalise such co-operation. As a result of amendments, the Bill already supports the idea of joint committees between patients forums to enable that to happen. We have already made it clear that forums in each area should share administrative and professional support, so that expertise can be located in one place.
The amendments tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) take those issues a step further. I shall say more about that shortly, but first I want to say something about another issue, which was in the NHS plan and has been stressed throughout the consultation. We need an independent advocacy service for patients in every part of the country, because however good the system is in each trust things will go wrong and will not be sorted out, and someone will not then be able to rely on a part of the NHS to take them through the complaints procedure and ensure that they are looked after.
We are talking about a service that has never existed uniformly in the NHS. Some community health councils have provided it, but others have not. As we have made clear, we will ensure that independent advocacy services exist in every part of the country. That represents a major step forward in patient rights in the NHS, but my hon. Friend the Member for Wakefield seeks to go further by enshrining it in the Bill.
The NHS has long lacked any democratic scrutiny at local level. The Bill provides for overview committees to scrutinise the service locally, and to scrutinise joint work between the NHS and local authorities, in exactly the same way as the work of local authorities is scrutinised.
I want to leave time for the hon. Member for Woodspring (Dr. Fox), so I shall be brief. During consultation, organisations stressed the need for a national body representing patients' interests—a body that could represent patients, while also supporting those whom we want to volunteer to serve on patients forums. We are already working on a study, instigated by patients organisations, on the best way to set up such a body.
From the outset, we have stressed our wish to ensure that the experience and expertise of CHC members and staff can be retained in the NHS. We expect local health


communities to help CHC staff to find new employment. As I think my speech should make clear, in future there will be more rather than fewer opportunities to work in patient empowerment and scrutiny in and around the NHS than there are at present, backed up by our commitment of an additional £10 million of investment—a sum that builds on the funds already available for CHCs.
What we have already done has greatly strengthened the voice of patients in the NHS. The Opposition amendments tie us to a system that, however hard people have worked, is not right for the modern NHS. My hon. Friend the Member for Wakefield has raised an important point. We have already said—indeed, we have said it in the Bill—that patients forums should work together; my hon. Friend says we should go further and legislate for a patients council capable of facilitating the co-ordination of the work of patients forums as well as other functions.
I think that the case has been made very clearly that there are people whose problems begin in primary care, continue in the ambulance trust and end up in the hospital trust, perhaps then returning to primary care in a long stay context. We need co-ordination across the system. My hon. Friend is, I think, right to want the Bill to include provision for a patients forum.
I have said that we will provide a common secretariat to support patients in each area. Amendment No. 26 would enshrine that responsibility in the Bill and extend it to providing support for the patients councils. That would ensure that the new organisations had a coherent structure at local level.
Although we have made this commitment from the outset, a case has been made that it would be a big step forward to include—for the first time in the 50 or more years since the NHS was founded—the provision of independent advocacy in NHS legislation. New clause 10 will do just that. It also places a responsibility on the Secretary of State to consult with interested bodies, but particularly with patients councils, on the best location of those services.
Nevertheless, although we accept the amendments in this group tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), which will enable us to create a better structure, much of the necessary action is not purely legislative. We must have clear signposting to the new advocacy services. Additionally, the telephone number, like that for NHS Direct, should be the same in every part of the country so that people are routed to the service.
I have again set out our proposals and stated very clearly how we have already responded to the issues raised in consultation. I have also dealt with and accepted the new clauses and amendments tabled by my hon. Friend the Member for Wakefield. I know that the hon. Member for Woodspring would now like to reply to the debate.

Dr. Fox: I am so grateful for the crumbs that the Minister has seen fit to leave the Opposition to reply to the debate.
Very many questions remain completely unanswered. Despite repeatedly asking the Minister, we still do not know how much the new system will cost. We still do not really know what will happen to CHC staff and to CHC

medical records. CHCs keep a huge amount of confidential information. Will that be returned to patients doctors or go to hospital trusts? What about cases in which patients have complained about those very hospitals or trusts? who owns the information and where will it go?
The Government's approach of abolition is illogical. As the Minister and some Labour Members said, some CHCs are excellent. An argument made repeatedly today by Opposition Members is that we have to bring the standards of the poorest up to those of the best. If it is possible for CHCs in some parts of the country to be excellent and to provide the standards and services that many hon. Members and very many members of the public claim they offer, that should be an argument for reform.
On Second Reading. the hon. Member for Wakefield (Mr. Hinchliffe) said—he quoted it himself today—that the abolition of CHCs and scrutiny were an "afterthought" in the Government's plan. I am sure that most hon. Members agree that if his new clauses are accepted, that would diminish the damage that would be done by the Government's original proposals. However, I am sorry that he did not throw his considerable weight in the House behind new clause 2 and fight for proper reform of CHCs.
The hon. Member for Sutton and Cheam (Mr. Burstow) said that the provision is just an extra tier on top of the Government's proposals, and I have much sympathy with that comment. It certainly means more complexity and a more labyrinthine structure. I wonder about the whole concept of a single point of access. As was mentioned in the debate, what about a patient who, in a single episode of illness, has several complaints about different bodies? Where is his or her single point of entry to the system? I am not sure that the new clauses tabled by the hon. Member for Wakefield identify that point.
My hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson) described local examples of CHCs working well and the need for reform. My hon. Friend the Member for Eddisbury (Mr. O'Brien) started the ball rolling with his expos" of the Prime Minister's cynical use of the term "consultation". He gave the House a very good example of ht w the culture of this Government operates.
It is sad that the Labour Back Benchers who spoke at length on Second Reading about their opposition to the principle of abolishing CHCs have been absent from this debate. Notably missing have been those Labour Members who haw been going around Westminster telling us privately how much they hate the Government's proposals. We did no hear much from them in the debate.
It has been a genuinely sorry tale. There has been a refusal to apologise for claiming consultation when there was none, and a refusal to be properly accountable to those who are most involved—the CHCs. Despite knowing that he was going to change the system at the end of this debate, the Prime Minister refused to give a straight answer to straight questions at Prime Minister's questions today. The Minister could not even give us a straight answer to the straightest question of all—was there consultation with the CHCs before their abolition was announced in the national plan? If they were thirsty, they could not ask for water.
New clause 2 does not tie us to a failed system; the only thing it ties anyone to is reform. The new clause would bring the standard of the poorest up to that of the


best. We did not want CHCs to be abolished. We will continue to fight to thwart the Government's plans beyond this House in the other place, so that these proposals go into the general election—

It being Nine o'clock, MR. DEPLIT Y SPEAKER proceeded to put the Question already proposed from the Chair, pursuant to Order [this day].

The House divided: Ayes 163, Noes 301.

Division No. 123]
[9 pm


AYES


Ainsworth, Peter (E Surrey)
Greenway, John


Allan, Richard
Grieve, Dominic


Amess, David
Gummer, Rt Hon John


Arbuthnot, Rt Hon James
Hague, Rt Hon William


Ashdown, Rt Hon Paddy
Hamilton, Rt Hon Sir Archie


Atkinson, Peter (Hexham)
Hammond, Philip


Baldry, Tony
Hancock, Mike


Ballard, Jackie
Hayes, John


Beggs, Roy
Heald, Oliver


Beith, Rt Hon A J
Heath, David (Somerton & Frome)


Bell, Martin (Tatton)
Heathcoat-Amory, Rt Hon David


Bercow, John
Hogg, Rt Hon Douglas


Beresford, Sir Paul
Horam, John


Blunt, Crispin
Howard, Rt Hon Michael


Body, Sir Richard
Howarth Gerald (Aldershot)


Boswell, Tim
Hughes, Simon (Southwark N)


Bottomley, Peter (Worthing W)
Hunter, Andrew


Bottomley, Rt Hon Mrs Virginia
Jackson Robert (Wantage)


Brady, Graham
Jenkin, Bernard


Brake, Tom
Johnson Smith, Rt Hon Sir Geoffrey


Brand, Dr Peter



Brazier, Julian
Keetch, Paul


Breed, Colin
Key, Robert


Brooke, Rt Hon Peter
Kirkbride, Miss Julie


Browning, Mrs Angela
Kirkwood, Archy


Bruce, Malcolm (Gordon)
Laing, Mrs Eleanor


Burnett, John
Lait, Mrs Jacqui


Burns, Simon
Lansley, Andrew


Burstow, Paul
Leigh, Edward


Butterfill, John
Letwin, Oliver


Cash, William
Lewis, Dr Julian (New Forest E)


Chapman, Sir Sydney (Chipping Barnet)
Lidington, David



Livsey, Richard


Chope, Christopher
Lloyd, Rt Hon Sir Peter (Fareham)


Clark, Dr Michael (Rayleigh)
Loughton, Tim


Collins, Tim
Lyell, Rt Hon Sir Nicholas


Cormack, Sir Patrick
McCrea, Dr William


Cotter, Brian
McIntosh, Miss Anne


Cran, James
MacKay Rt Hon Andrew


Curry, Rt Hon David
Maclean Rt Hon David


Davey, Edward (Kingston)
McLoughlin, Patrick


Davies, Quentin (Grantham)

Malins, Humfrey


Davis, Rt Hon David (Haltemprice)
Mates, Michael


Day, Stephen
Michie, Mrs Ray (Argyll & Bute)


Duncan, Alan
Moore, Michael


Emery, Rt Hon Sir Peter
Moss, Malcolm


Evans, Nigel
Nicholls, Patrick


Fabricant, Michael
Norman. Archie


Fallon, Michael
Oaten, Mark


Flight, Howard
O'Brien, Stephen (Eddisbury)


Forth, Rt Hon Eric
Öpik, Lembit


Fowler, Rt Hon Sir Norman
Ottaway Richard


Fox, Dr Liam
Page, Richard


Gale, Roger
Pickles, Eric


Garnier, Edward
Portillo, Rt Hon Michael


George, Andrew (St Ives)
Prior, David


Gibb, Nick
Randall, John


Gidley, Sandra
Redwood, Rt Hon John


Gill, Christopher
Rendel, David


Gillan, Mrs Cheryl
Robertson, Laurence (Tewk'b'ry)


Gorman, Mrs Teresa
Roe, Mrs Marion (Broxbourne)


Gray, James
Russell, Bob (Colchester)





St Aubyn, Nick
Townend, John


Sanders, Adrian
Tredinnick, David


Sayeed, Jonathan
Trend, Michael


Shephard, Rt Hon Mrs Gillian
Tyler, Paul


Shepherd, Richard
Viggers, Peter


Simpson, Keith (Mid-Norfolk)
Walter, Robert


Smith, Sir Robert (W Ab'd'ns)
Waterson, Nigel


Smyth, Rev Martin (Belfast S)
Webb, Steve


Spelman, Mrs Caroline
Whitney, Sir Raymond


Spring Richard
Whittingdale, John


Stanley, Rt Hon Sir John
Widdecombe, Rt Hon Miss Ann


Steen Anthony
Wilkinson, John


Streeter, Gary
Willetts, David


Swayne, Desmond
Willis, David



Willshire, David


Syms, Robert
Winterton, Mrs Ann (Congleton)


Taylor, Ian (Esher & Walton)
Winterton, Nicholas (Macclesfield)


Taylor, Rt Hon John D (Strangford)
Yeo, Tim


Taylor, John M (Solihull)
Young, Rt Hon Sir George


Taylor, Matthew (Truro)



Taylor, Sir Teddy
Tellers for the Ayes:


Thomas, Simon (Ceredigion)
Mr. Peter Luff and


Tonge, Dr Jenny
Mr. Geoffrey Clifton-Brown.




NOES


Adams, Mrs Irene (Paisley N)
Clarke, Charles (Norwich S)


Ainger, Nick
Clarke, Eric (Midlothian)


Ainsworth, Robert (Cov'try NE)
Clarke, Rt Hon Tom (Coatbridge)


Allen, Graham
Clarke, Tony (Northampton S)


Anderson, Rt Hon Donald (Swansea E)
Clelland, David



Coaker, Vernon


Anderson, Janet (Rossendale)
Coffey, Ms Ann


Armstrong, Rt Hon Ms Hilary
Cohen, Harry


Ashton, Joe
Coleman, Iain


Atkins, Charlotte
Colman, Tony


Austin, John
Connarty, Michael


Bailey, Adrian
Cooper, Yvette


Banks, Tony
Corbett, Robin


Barnes, Harry
Corbyn, Jeremy


Barron, Kevin
Cousins, Jim


Battle, John
Cox, Tom


Bayley, Hugh
Cranston, Ross


Beard, Nigel
Crausby, David


Beckett, Rt Hon Mrs Margaret
Cryer, John (Hornchurch)


Begg, Miss Anne
Cummings, John


Bell, Stuart (Middlesbrough)
Darling, Rt Hon Alistair


Benn, Hilary (Leeds C)
Darvill, Keith


Benn, Rt Hon Tony (Chesterfield)
Davey, Valerie (Bristol W)


Bennett, Andrew F
Davidson, Ian


Benton, Joe
Davies, Rt Hon Denzil (Llanelli)


Bermingham, Gerald
Davies, Geraint (Croydon C)


Berry, Roger
Davis, Rt Hon Terry (B'ham Hodge H)


Best, Harold



Betts, Clive
Dawson, Hilton


Blears, Ms Hazel
Denham, Rt Hon John


Blizzard, Bob
Dismore, Andrew


Borrow, David
Dobbin, Jim


Bradshaw, Ben
Dobson, Rt Hon Frank


Brinton, Mrs Helen
Donohoe, Brian H


Brown, Russell (Dumfries)
Doran, Frank


Browne, Desmond
Dowd, Jim


Buck, Ms Karen
Drew, David


Burden, Richard
Dunwoody, Mrs Gwyneth


Burgon, Colin
Eagle, Angela (Wallasey)


Byers, Rt Hon Stephen
Eagle, Maria (L'pool Garston)


Campbell, Mrs Anne (C'bridge)
Edwards, Huw


Campbell, Ronnie (Blyth V)
Efford, Clive


Campbell-Savours, Dale
Ellman, Mrs Louise


Cann, Jamie
Ennis, Jeff


Caplin, Ivor
Etherington, Bill


Cawsey, Ian
Fisher, Mark


Chapman, Ben (Wirral S)
Fitzpatrick, Jim


Chaytor, David
Fitzsimons, Mrs Lorna


Clapham, Michael
Flint, Caroline


Clark, Rt Hon Dr David (S Shields)
Flynn, Paul


Clark, Paul (Gillingham)
Foster, Rt Hon Derek






Foulkes, George
McDonagh, Siobhain


George, Rt Hon Bruce (Walsall S)
Macdonald, Calum


Gerrard, Neil
McDonnell, John


Gibson, Dr Ian
McIsaac, Shona


Gilroy, Mrs Linda
Mackinlay, Andrew


Goggins, Paul
McNamara, Kevin


Golding, Mrs Llin
McNulty, Tony


Griffiths, Jane (Reading E)
Mactaggart, Fiona


Griffiths, Nigel (Edinburgh S)
McWalter, Tony


Griffiths, Win (Bridgend)
McWilliam, John


Grocott, Bruce
Mahon, Mrs Alice


Grogan, John
Mallaber, Judy


Gunnell, John
Mandelson, Rt Hon Peter


Hall, Mike (Weaver Vale)
Marsden, Gordon (Blackpool S)


Hamilton, Fabian (Leeds NE)
Marsden, Paul (Shrewsbury)


Hanson, David
Marshall, David (Shettleston)


Harman, Rt Hon Ms Harriet
Marshall, Jim (Leicester S)


Healey, John
Martlew, Eric


Henderson, Doug (Newcastle N)
Meacher, Rt Hon Michael


Henderson, Ivan (Harwich)
Meale, Alan


Hendrick, Mark
Merron, Gillian


Hepburn, Stephen
Michael, Rt Hon Alun


Heppell, John
Michie, Bill (Shefld Heeley)


Hesford, Stephen
Milburn, Rt Hon Alan


Hewitt, Ms Patricia
Miller, Andrew


Hinchliffe, David
Mitchell, Austin


Hodge, Ms Margaret
Moffatt, Laura


Hope, Phil
Morgan, Ms Julie (Cardiff N)


Hopkins, Kelvin
Morris, Rt Hon Ms Estelle (B'ham Yardley)


Howarth, George (Knowsley N)



Howells, Dr Kim
Morris, Rt Hon Sir John (Aberavon)


Hoyle, Lindsay



Hughes, Ms Beverley (Stretford)
Mullin, Chris


Hughes, Kevin (Doncaster N)
Murphy, Denis (Wansbeck)


Humble, Mrs Joan
Murphy, Rt Hon Paul (Torfaen)


Hutton, John
Naysmith, Dr Doug


Iddon, Dr Brian
Norris, Dan


Illsley, Eric
O'Brien, Bill (Normanton)


Jackson, Helen (Hillsborough)
O'Hara, Eddie


Jamieson, David
Olner, Bill


Jenkins, Brian
O'Neill, Martin


Johnson, Alan (Hull W & Hessle)
Organ, Mrs Diana


Jones, Mrs Fiona (Newark)
Pickthall, Colin


Jones, Helen (Warrington N)
Pike, Peter L


Jones, Ms Jenny (Wolverh'ton SW)
Pond, Chris



Pope, Greg


Jones, Jon Owen (Cardiff C)
Pound, Stephen


Jones, Dr Lynne (Selly Oak)
Powell, Sir Raymond


Jones, Martyn (Clwyd S)
Prentice, Ms Bridget (Lewisham E)


Jowell, Rt Hon Ms Tessa
Prentice, Gordon (Pendle)


Joyce, Eric
Primarolo, Dawn


Kaufman, Rt Hon Gerald
Prosser, Gwyn


Keeble, Ms Sally
Purchase, Ken


Keen, Alan (Feltham & Heston)
Quin, Rt Hon Ms Joyce


Keen, Ann (Brentford & Isleworth)
Quinn, Lawrie


Kemp, Fraser
Rammell, Bill


Kidney, David
Raynsford, Nick


Kilfoyle, Peter
Reed, Andrew (Loughborough)


King, Andy (Rugby & Kenilworth)
Robertson, John (Glasgow Anniesland)


Kumar, Dr Ashok



Ladyman, Dr Stephen
Robinson, Geoffrey (Cov'try NW)


Lammy, David
Rogers, Allan


Lawrence, Mrs Jackie
Rooker, Rt Hon Jeff


Laxton, Bob
Rooney, Terry


Lepper, David
Ross, Ernie (Dundee W)


Leslie, Christopher
Rowlands, Ted


Levitt, Tom
Ruane, Chris


Lewis, Ivan (Bury S)
Ruddock, Joan


Liddell, Rt Hon Mrs Helen
Russell, Ms Christine (Chester)


Linton, Martin
Ryan, Ms Joan


Lock, David
Salter, Martin


Love, Andrew
Sarwar, Mohammad


McAvoy, Thomas
Savidge, Malcolm


McCabe, Steve
Sawford, Phil


McCartney, Rt Hon Ian (Makerfield)
Sedgemore, Brian



Sheldon, Rt Hon Robert





Shipley, Ms Debra
Trickett, Jon


Singh, Marsha
Turner, Dennis (Wolverh'ton SE)


Skinner, Dennis
Turner, Dr Desmond (Kemptown)


Smith, Rt Hon Andrew (Oxford E)
Turner, Dr George (NW Norfolk)


Smith, Miss Geraldine (Morcambe & Lunesdale)
Turner, Neil (Wigan)



Twigg, Derek (Halton)


Smith, Jacqui (Redditch)
Twigg, Stephen (Enfield)


Smith, John (Glamorgan)
Vis, Dr Rudi


Soley, Clive
Walley, Ms Joan


Southworth, Ms Helen
Ward, Ms Claire


Spellar, John
Wareing, Robert N


Squire, Ms Rachel
Watts, David


Starkey, Dr Phyllis
White, Brian


Steinberg, Gerry
Whitehead, Dr Alan


Stewart, Ian (Eccles)
Wicks, Malcolm


Stinchcombe, Paul
Williams, Rt Hon Alan (Swansea W)


Stoate, Dr Howard
Williams, Alan W (E Carmarthen)


Strang, Rt Hon Dr Gavin
Williams, Mrs Betty (Conwy)


Stringer, Graham
Wills, Michael


Stuart, Ms Gisela
Winnick, David


Sutcliffe, Gerry
Winterton, Ms Rosie (Doncaster C)


Taylor, Rt Hon Mrs Ann (Dewsbury)
Woodward, Shaun



Woolas, Phil


Taylor, Ms Dari (Stockton S)
Wray, James


Taylor, David (NW Leics)
Wright, Anthony D (Gt Yarmouth)


Temple-Morris, Peter
Wright, Tony (Cannock)


Thomas, Gareth R (Harrow W)



Timms, Stephen
Tellers for the Noes:


Tipping, Paddy
Mr. Don Touhig and


Todd, Mark
Mr. Ian Pearson.

Question accordingly negatived.

Mr. Deputy Speaker: With the leave of the House, I shall put together new clauses 9 and 10.

New Clause 9

PATIENTS' COUNCILS

".—(1) The Secretary of State shall by regulations provide for the establishment of bodies to be known as Patients' Councils (referred to in this section as "Councils") the members of which are to be appointed in each case b v two or more Patients' Forums.

(2) The regulations shall provide for determining—

(a) the Patients' loruins by which the members of a Council are to be app Hinted, and
(b) the area in relation to which the functions of a Council are exercisable.

(3) The functions of a Council are—

(a) to facilitate he co-ordination by member Forums of their activities;
(b) to make reports to health authorities, local authorities and their committees and to the Secretary of State in accordance with the regulations;
(c) to carry out such arrangements as may be made with the Council under section I9A of the 1977 Act (independent advocacy services);
(d) such other functions as the regulations may prescribe.

(4) The "member Forums" of a Council are the Patients' Forums by which its members are for the time being appointed.'.

New Clause 10

INDEPENDENT ADVOCACY SERVICES

". After section 19 of the 1977 Act there shall be inserted—

19A.—(1) It is the duty of the Secretary of State to arrange, to such extent as he considers necessary to meet all reasonable requirements, for the provision of independent advocacy services.

(2) "Independent advocacy services" are services providing assistance (by way of representation or otherwise) to individuals making or intending to make—

(a) a complaint under a procedure operated by a health service body or independent provider,
(b) a complaint to the Health Service Commissioner for England or the Health Service Commissioner for Wales,
(c) a complaint of a prescribed description which relates to the provision of services as part of the health service and

(i) is made under a procedure of a prescribed description, or
(ii) gives rise, or may give rise, to proceedings of a prescribed description.

(3) In subsection (2)—
health service body" mean a body which, under section 2(1) or (2) of the Health Service Commissioners Act 1993, is subject to investigation by the Health Service Commissioner for England c r the Health Service Commissioner for Wales;
independent provider" means a person who, under section 2B(1) or (2) of that Act, is subject to such investigation.

(4) The Secretary of State may make such other arrangements as he thinks fit for the provision of assistance to individuals in connection with complaints relating to the provision of services as part of the health service.

(5) In making arrangements under this section the Secretary of State must have regard to the principle that the provision of services under the arrangements should, so far as practicable, be independent of any person who is the subject of a relevant complaint or is involved in investigating or adjudicating on such a complaint.

(6) Before making arrangements under this section in respect of complaints relating to the provision of any services, the Secretary of State shall consult—

(a) any relevant Patients' Council, and
(b) such other persons as he consit ers appropriate.

(7) A Patients' Council is, for the purposes of subsection (6)(a), a relevant Council if the services concerned are ones to which functions of a member Forum of the Council relate.

(8) The Secretary of State may make payments to any person in pursuance of arrangements under this section.".'.—[Mr. Jamieson.]

Brought up, and read the First time.

Motion made, and Question put, That the clauses be read a Second time:—

The House divided: Ayes 335, Noes 124.

Division No. 126]
[9.17 pm


AYES


Adams, Mrs Irene (Paisley N)
Berth, Rt Hon A J


Ainger, Nick
Bell, Martin (Tatton)


Ainsworth, Robert (Cov'try NE)
Bell, Stuart (Middlesbrough)


Allan, Richard
Benn, Hilary (Leeds C)


Allen, Graham
Benn, Rt Hon Tony (Chesterfield)


Anderson, Rt Hon Donald (Swansea E)
Bennett, Andrew F



Benton, Joe


Armstrong, Rt Hon Ms Hilary
Bermingham, Gerald


Ashdown, Rt Hon Paddy
Berry, Roger


Ashton, Joe
Best, Harold


Atkins, Charlotte
Belts, Clive


Austin, John
Blears, Ms Hazel


Bailey, Adrian
Blizzard, Bob


Ballard, Jackie
Borrow, David


Banks, Tony
Bradshaw, Ben


Barnes, Harry
Brake, Tom


Barron, Kevin
Brand, Dr Peter


Battle, John
Breed, Colin


Bayley, Hugh
Brinton, Mrs Helen


Beard, Nigel
Brown, Russell (Dumfries)


Beckett, Rt Hon Mrs Margaret
Browne, Desmond


Begg, Miss Anne
Bruce, Malcolm (Gordon)





Buck, Ms Karen
Gidley, Sandra


Burden, Richard
Gilroy, Mrs Linda


Burnett, John
Goggins, Paul


Burstow, Paul
Golding, Mrs Llin


Byers, Rt Hon Stephen
Griffiths, Jane (Reading E)


Campbell, Mrs Anne (C'bridge)
Griffiths, Nigel (Edinburgh S)


Campbell, Ronnie (Blyth V)
Griffiths, Win (Bridgend)


Campbell-Savours, Dale
Grogan John


Cann, Jamie
Gunnell, John


Caplin, Ivor
Hall, Mike (Weaver Vale)


Caton, Martin
Hamilton, Fabian (Leeds NE)


Chapman, Ben (Wirral S)
Hancock, Mike


Chaytor, David
Hanson, David


Clapham, Michael
Harman, Rt Hon Ms Harriet


Clark, Rt Hon Dr David (S Shields)
Harris, Dr Evan


Clark, Paul (Gillingham)
Harvey, Nick


Clarke, Eric (Midlothian)
Healey, John


Clarke, Rt Hon Tom (Coatbridge)
Heath, David (Somerton & Frome)


Clarke, Tony (Northampton S)
Henderson, Doug (Newcastle N)


Clelland, David
Henderson, Ivan (Harwich)


Coaker, Vernon
Hendrick, Mark


Coffey, Ms Ann
Hepburn, Stephen


Cohen, Harry
Heppell, John


Coleman, Iain
Hesford, Stephen


Colman, Tony
Hewitt, Ms Patricia


Connarty, Michael
Hinchliffe, David


Cooper, Yvette
Hodge, Ms Margaret


Corbett, Robin
Hope, Phil


Corbyn, Jeremy
Hopkins, Kelvin


Cotter, Brian
Howarth, George (Knowsley N)


Cousins, Jim
Howells, Dr Kim


Cox, Tom
Hoyle, Lindsay


Cranston, Ross
Hughes, Ms Beverley (Stretford)


Crausby, David
Hughes, Kevin (Doncaster N)


Cryer, John (Hornchurch)
Hughes, (Southwark N)


Cummings, John
Humble, Mrs Joan


Cunningham, Jim (Cov"try S)
Humble, Mrs Joan


Darling, Rt Hon Alistair
Hutton, John


Darvill, Keith
Iddon, Dr Brian


Davey, Edward (Kingston)
Illsley, Eric


Davey, Valerie (Bristol W)
Jackson, Helen (Hillsborough)


Davidson, Ian
Jamieson, David


Davies, Rt Hon Denzil (Llanelli)
Jenkins, Brian


Davies, Geraint (Croydon C)
Johnson, Alan (Hull W & Hassle)


Davis, Rt Hon Terry (B"ham Hodge H)
Jones, Mrs Fiona (Newark)



Jones, Helen (Warrington N)


Dawson, Hilton
Jones, Ms Jenny (Wolverh"ton SW)


Denham, Rt Hon John



Dismore, Andrew
Jones, Jon Owen (Cardiff C)


Dobbin, Jim
Jones, Dr Lynne (Selly Oak)


Dobson, Rt Hon Frank
Jones, Martyn (Clwyd S)


Donohoe, Brian H
Jowell, Rt Hon Ms Tessa


Doran, Frank
Joyce, Eric


Dowd, Jim
Kaufman, Rt Hon Gerald


Drew, David
Keeble, Ms Sally


Dunwoody, Mrs Gwyneth
Keen, Alan (Feltham & Heston)


Eagle, Angela (Wallasey)
Keen, Ann (Brentford & Isleworth)


Eagle, Maria (L'pool Garston)
Keetch, Paul


Edwards, Huw
Kemp, Fraser


Efford, Clive
Kidney, David


Ellman, Mrs Louise
Kilfoyle, Peter


Ellman, Mrs Louise
Kilfoyle, Peter


Ennis, Jeff
King, Andy (Rugby & Kenilworth)


Etherington, Bill



Fisher, Mark
Kirkwood, Archy


Fitzpatrick, Jim
Kumar, Dr Ashok


Fitzsimons, Mrs Lorna
Ladyman, Dr Stephen


Flint, Caroline
Lammy, David


Flynn Paul
Lawrence, Mrs Jackie


Foster, Rt Hon Derek
Laxton, Bob


Foulkes, George
Lepper, David


Galloway, George
Leslie, Christopher


George, Andrew (St Ives)
Levitt, Tom


George, Rt Hon Bruce (Walsall S)
Lewis, Ivan (Bury S)


Gerrard, Neil
Liddell, Rt Hon Mrs Helen


Gibson, Dr Ian
Linton, Martin






Livsey, Richard
Rooker, Rt Hon Jeff


Lock, David
Rooney, Terry


Love, Andrew
Ross, Ernie (Dundee W)


McAvoy, Thomas
Rowlands, Ted


McCabe, Steve
Ruane, Chris


McCartney, Rt Hon Ian (Makerfield)
Ruddock, Joan



Russell, Bob (Colchester)


McDonagh Siobhain
Russel1, Ms Christine (Chester)


Macdonald, Calum
Ryan, Ms Joan


McDonnell, John
Salter, Martin


McIsaac, Shona
Sanders, Adrian


Mackinlay, Andrew
Sarwar, Mohammad


McNamara, Kevin
Savidge, Malcolm


McNulty, Tony
Sawford Phil


Mactaggart, Fiona
Sedgemore, Brian


McWalter, Tony
Sheldon, Rt Hon Robert


McWilliam, John
Shipley, Ms Debra


Mahon, Mrs Alice
Singh, Marsha


Mallaber, Judy
Skinner, Dennis



Mandelson, Rt Hon Peter
Smith, Rt Hon Andrew (Oxford E)


Marsden, Gordon (Blackpool S)
Smith, Miss Geraldine (Morecambe & Lunesdale)


Marsden, Paul (Shrewsbury)
Smith, Jacqui (Redditch)


Marshall, David (Shettleston)
Smith, John (Glamorgan)


Marshall, Jim (Leicester S)
Smith, Sir Robert (W Ab'd'ns)


Martlew, Eric
Soley, Clive


Meacher, Rt Hon Michael
Southworth, Ms Helen


Meale, Alan
Spellar, John


Merron, Gillian
Squire, Ms Rachel


Michael, Rt Hon Alun
Starkey, Dr Phyllis


Michie, Bill (Shefld Heeley)
Steinberg, Gerry


Michie, Mrs Ray (Argyll & Bute)
Stewart, Ian (Eccles)


Milburn, Rt Hon Alan
Stinchcombe, Paul


Miller, Andrew
Stoate, Dr Howard


Moffatt Laura
Strang, Rt Hon Dr Gavin


Moore, Michael
Stuart, Ms Gisela


Morgan, Ms Julie (Cardiff N)
Stunell, Andrew


Morris, Rt Hon Ms Estelle (B'ham Yardley)
Sutcliffe Gerry



Taylor, Rt Hon Mrs Ann (Dewsbury)


Morris, Rt Hon Sir John (Aberavon)




Taylor, Ms Dari (Stockton S)


Mulllin, Chris
Taylor, David (NW Leics)


Murphy, Denis (Wansbeck)
Taylor Rt Hon John D (Strangford)


Murphy, Rt Hon Paul (Torfaen)
Temple-Morris, Peter


Naysmith, Dr Doug
Thomas, Gareth R (Harrow W)


Morris, Dan
Timms, Stephen


Oaten, Mark
Tipping, Paddy


O'Brien, Bill (Normanton)
Todd, Mark


O'Hara, Eddie
Tonge, Dr Jenny


Olner, Bill
Trickett, Jon


O'Neill, Martin
Turner, Dr Desmond (Kemptown)


Öpik, Lembit
Turner, Dr George (NW Norfolk)


Organ, Mrs Diana
Turner, Neil (Wigan)


Pickthall, Colin
Twigg, Derek (Halton)


Pike, Peter L
Twigg, Stephen (Enfield)


Pond, Chris
Tyler, Paul


Pope, Greg
Vis, Dr Rudi


Pound, Stephen
Walley, Ms Joan


Powell, Sir Raymond
Ward, Ms Claire


Prentice, Ms Bridget (Lewisham E)
Wareing, Robert N


Prentice, Gordon (Pendle)
Watts, David



Webb, Steve


Primarolo, Dawn
White, Brian


Prosser, Gwyn
Whitehead, Dr Alan


Purchase, Ken
Wicks, Malcolm


Quin, Rt Hon Ms Joyce
Williams, Rt Hon Alan (Swansea W)


Quinn, Lawrie



Rammell, Bill
Williams, Allan W (E Carmarthen)


Raynsford, Nick
Williams, Mrs Betty (Conwy)


Reed, Andrew (Loughborough)
Willis, Phil


Rendel, David
Wills, Michael


Robertson, John (Glasgow Anniesland)
Winnick, David



Winterton, Ms Rosie (Doncaster C)


Robinson, Geoffrey (Cov'try NW)
Woodward, Shaun


Rogers, Allan
Woolas, Phil





Wray, James
Tellers for the Ayes:


Wright, Anthony D (Gt Yarmouth)
Mr. Don Touhig and


Wright, Tony (Cannock)
Mr. Ian Pearson.




NOES


Ainsworth, Peter (E Surrey)
Laing, Mrs Eleanor


Amess, David
Lait, Mrs Jacqui


Arbuthnot, Rt Hon James
Lansley, Andrew


Atkinson, Peter (Hexham)
Leigh, Edward


Baldry, Tony
Letwin, Oliver


Beggs, Roy
Lewis, Dr Julian (New Forest E)


Bercow, John
Lidington, David


Beresford, Sir Paul
Lloyd, Rt Hon Sir Peter (Fareham)


Blunt, Crispin
Loughton, Tim


Body, Sir Richard
Lyell, Rt Hon Sir Nicholas



Boswell, Tim
McCrea, Dr William


Bottomley, Peter (Worthing W)
McIntosh, Miss Anne


Bottomley, Rt Hon Mrs Virginia
Maclean, Rt Hon David


Brady, Graham
McLoughlin, Patrick


Brazier, Julian
Malins, Humfrey


Brooke, Rt Hon Peter
Mates, Michael


Browning, Mrs Angela
Moss, Malcolm


Burns, Simon
Nicholls, Patrick


Butterfill, John
Norman, Archie


Cash, William
O'Brien, Stephen (Eddisbury)


Chapman, Sir Sydney (Chipping Barnet)
Ottaway, Richard



Page, Richard


Chope, Christopher
Pickles, Eric


Clark, Dr Michael (Rayleigh)
Portillo, Rt Hon Michael


Collins, Tim
Prior, David


Cormack, Sir Patrick
Randall, John


Cran, James
Redwood, Rt Hon John


Curry, Rt Hon David
Robertson, Laurence (Tewk'b'ry)


Davies, Quentin (Grantham)
Roe, Mrs Marion (Broxbourne)


Davis, Rt Hon David (Haltemprice)
St Aubyn, Nick


Day, Stephen
Sayeed, Jonathan


Duncan Alan
Shephard, Rt Hon Mrs Gillian


Emery, Rt Hon Sir Peter
Shepherd, Richard


Evans, Niqel
Simpson, Keith (Mid-Norfolk)


Fabricant, Michael
Smyth, Rev Martin (Belfast S)


Fallon, Michael
Spelman, Mrs Caroline


Flight, Howard
Spring, Richard


Forth, Rt Hon Eric
Stanley, Rt Hon Sir John


Fowler, Rt Hon Sir Norman
Steen Anthony



Streeter, Gary


Fox, Dr Liam
Swayne, Desmond


Gale, Roger
Syms, Robert


Garnier, Edward
Taylor, Ian (Esher & Walton)


Gibb, Nick
Taylor, John M (Solihull)


Gill, Christopher
Taylor, Sir Teddy


Gillan, Mrs Cheryl
Thomas, Simon (Ceredigion)


Gorman, Mrs Teresa
Townend, John


Gray, James
Tredinnick, David


Greenway, John
Trend Michael


Grieve, Dominic
Viggers, Peter


Hamilton, Rt Hon Sir Archie
Walter, Robert


Hammond, Philip
Waterson, Nigel


Hayes, John
Whitney, Sir Raymond


Heald, Oliver
Whittingdale, John


Heathcoat-Amory, Rt Hon David
Widdecombe, Rt Hon Miss Ann


Hogg, Rt Hon Douglas
Wilkinson, John


Horam, John
Willetts, David


Howard, Rt Hon Michael
Wilshire, David


Howarth, Gerald (Aldershot)
Winterton, Mrs Ann (Congleton)


Hunter, Andrew
Winterton, Nicholas (Macclesfield)


Jackson, Robert (Wantage)
Yeo, Tim


Jenkin, Bernard
Young, Rt Hon Sir George



Johnson Smith, Rt Hon Sir Geoffrey




Tellers for the Noes:


Key, Robert
Mr. Peter Luff and


Kirkbride, Miss Julie
Mr. Geoffrey Clifton-Brown.

Question accordingly agreed to.

Clauses read a Second time, and added to the Bill.

Question Put, That the remaining Government amendments and amendments Nos. 24 to 26 be made:—

The House divied: Ayes 338, Noes 118.

Division No. 127]
[9.31 pm


AYES


Adams, Mrs Irene (Paisley N)
Corbett, Robin


Ainger, Nick
Corbyn, Jeremy


Ainsworth, Robert (Cov'try NE)
Cotter, Brian


Allan, Richard
Cousins, Jim


Allen, Graham
Cox, Tom


Anderson, Rt Hon Donald (Swansea E)
Cranston, Ross



Crausby, David


Armstrong, Rt Hon Ms Hilary
Cryer, John (Hornchurch)


Ashdown, Rt Hon Paddy
Cummings, John


Ashton, Joe
Cunningham, Jim (Cov'try S)


Atkins, Charlotte
Darling, Rt Hon Alistair


Austin, John
Darvill, Keith


Bailey, Adrian
Davey, Edward (Kingston)


Ballard, Jackie
Davey, Valerie (Bristol W)


Banks, Tony
Davidson, Ian


Barnes, Harry
Davies, Rt Hon Denzil (Llanelli)


Battle, John
Davies, Geraint (Croydon C)


Bayley, Hugh
Davis, Rt Hon Terry (B'ham Hodge H)


Beard, Nigel



Beckett, Rt Hon Mrs Margaret
Dawson, Hilton


Begg, Miss Anne
Denham, Rt Hon John


Beith, Rt Hon A J
Dismore, Andrew


Bell, Martin (Tatton)
Dobbin, Jim


Bell, Stuart (Middlesbrough)
Dobson, Rt Hon Frank


Benn, Hilary (Leeds C)
Donohoe, Brian H


Bennett, Andrew F
Doran, frank


Benton, Joe
Dowd, Jim


Bermingham, Gerald
Drew, David


Berry, Roger
Dunwoody, Mrs Gwyneth


Best, Harold
Eagle, Angela (Wallasey)


Belts, Clive
Eagle, Maria (L'pool Garston)


Blears, Ms Hazel
Edwards, Huw


Blizzard, Bob
Efford, Clive


Borrow, David
Ellman, Mrs Louise


Bradshaw, Ben
Ennis, Jeff



Brake, Tom
Etherington, Bill


Brand, Dr Peter
Fisher, Mark


Breed, Colin
Fitzpatrick, Jim


Brinton, Mrs Helen
Fitzsimons, Mrs Lorna


Brown, Russell (Dumfries)
Flint, Caroline


Browne, Desmond
Flynn, Paul


Bruce, Malcolm (Gordon)
Foster, Rt Hon Derek


Buck, Ms Karen
Foulkes, George


Burden, Richard
Galloway, George


Burgon, Colin
George Andrew (St Ives)


Burnett, John
George Rt Hon Bruce (Walsall S)


Burstow, Paul
Gerrard, Neil


Byers, Rt Hon Stephen
Gibson, Dr Ian


Campbell, Mrs Anne (C'bridge)
Gidley, Sandra


Campbell, Ronnie (Blyth V)
Gilroy, Mrs Linda


Campbell-Savours, Dale
Goggins, Paul


Caplin, Ivor
Golding, Mrs Llin


Caton, Martin
Griffiths, Jane (Reading E)


Cawsey, Ian
Griffiths, Nigel (Edinburgh S)


Chapman, Ben (Wirral S)
Griffiths, Win (Bridgend)


Chaytor, David
Grocott, Bruce


Clapham, Michael
Grogan, John


Clark, Rt Hon Dr David (S Shields)
Gunnell, John


Clark, Paul (Gillingham)
Hall, Mike (Weaver Vale)



Clarke, Charles (Norwich S)
Hamilton, Fabian (Leeds NE)


Clarke, Eric (Midlothian)
Hancock, Mike


Clarke, Rt Hon Tom (Coatbridge)
Hanson, David



Clarke, Tony (Northampton S)
Herman, Rt Hon Ms Harriet


Clelland, David
Harris, Dr Evan


Coaker, Vernon
Harvey, Nick


Coffey, Ms Ann
Healey, John


Cohen, Harry
Heath, David (Somerton & Frome)


Coleman, Iain
Henderson, Doug (Newcastle N)


Colman, Tony
Henderson, Ivan (Harwich)


Connarty, Michael
Hendrick, Mark


Cooper, Yvette
Hepburn, Stephen





Heppell, John
Martlew, Eric



Hesford, Stephen
Meacher, Rt Hon Michael


Hewitt, Ms Patricia
Meale, Alan


Hinchliffe, David
Merron, Gillian


Hodge, Ms Margaret
Michael, Rt Hon Alun


Hope, Phil
Michie, Bill (Shefld Heeley)


Hopkins, Kelvin
Michie, Mrs Ray (Argyll & Bute)


Howarth, George (Knowsley N)
Milburn, Rt Hon Alan


Howells, Dr Kim
Miller, Andrew


Hoyle, Lindsay
Mitchell, Austin


Hughes, Ms Beverley (Stretford)
Moffatt, Laura


Hughes, Kevin (Doncaster N)
Moore, Michael


Hughes, Simon (Southwark N)
Morgan, Ms Julie (Cardiff N)


Humble, Mrs Joan
Morris, Rt Hon Ms Estelle (B'ham Yardley)


Hutton, John



Iddon, Dr Brian
Morris, Fit Hon Sir John (Aberavon)


Illsley, Eric



Jackson, Ms Glenda (Hampstead)
Mullin, Chris


Jackson, Helen (Hillsborough)
Murphy, Denis (Wansbeck)


Jamieson, David
Murphy, Rt Hon Paul (Torfaen)


Jenkins, Brian
Naysmith, Dr Doug


Johnson, Alan (Hull W & Hessle)
Norris, Dan


Jones, Mrs Fiona (Newark)
Oaten, Mark


Jones, Helen (Warrington N)
O'Brien, Bill (Normanton)


Jones, Ms Jenny (Wolverh"ton SW)
O'Hara, Eddie



Olner, Bill


Jones, Jon Owen (Cardiff C)
O'Neill, Martin


Jones, Dr Lynne (Selly Oak)
Öpik, Lembit


Jones, Martyn (Clwyd S)
Organ, Mrs Diana


Jowell, Rt Hon Ms Tessa
Pickthall, Colin


Joyce, Eric
Pike, Peter L


Kaufman, Rt Hon Gerald
Pond, Chris


Keeble, Ms Sally
Pope, Greg


Keen, Alan (Feltham & Heston)
Pound, Stephen


Keen, Ann (Brentford & Isleworth)
Powell, Sir Raymond


Keetch, Paul
Prentice, Ms Bridget (Lewisham E)


Kemp, Fraser
Prentice, Gordon (Pendle)


Kidney, David
Primarolo, Dawn


Kilfoyle, Peter
Prosser, Gwyn


King, Andy (Rugby & Kenilworth)
Purchase, Ken


Kirkwood, Archy
Quin, Rt Hon Ms Joyce


Kumar, Dr Ashok
Quinn, Lawrie


Ladyman, Dr Stephen
Rammell, Bill


Lammy, David
Raynsford, Nick


Lawrence, Mrs Jackie
Reed, Andrew (Loughborough)


Laxton, Bob
Rendel, David


Lepper, David
Robertson, John (Glasgow Anniesland)


Leslie, Christopher



Levitt, Tom
Robinson, Geoffrey (Cov'try NW)


Lewis, Ivan (Bury S)
Rogers, Allan


Liddell, Rt Hon Mrs Helen
Rooker, Rt Hon Jeff



Linton, Martin
Rooney, Terry


Livsey, Richard
Ross, Ernie (Dundee W)


Lock, David
Rowlands, Ted


Love, Andrew
Ruane, Chris


McAvoy, Thomas
Ruddock, Joan


McCabe, Steve
Russell, Bob (Colchester)


McCartney, Rt Hon Ian (Makerfield)
Russell, Ms Christine (Chester)



Ryan, Ms Joan


McDonagh, Siobhain
Salter, Martin


Macdonald, Calum
Sanders, Adrian


McDonnell, John
Sarwar, Mohammad


McIsaac, Shona
Savidge, Malcolm


Mackinlay, Andrew
Sawford, Phil


McNamara, Kevin
Sedgemore, Brian


McNulty, Tony
Sheldon, Rt Hon Robert


Mactaggart, Fiona
Shipley, Ms Debra


McWalter, Tony
Singh, Marsha


McWilliam, John
Skinner, Dennis


Mahon, Mrs Alice
Smith, Rt Hon Andrew (Oxford E)


Mallaber, Judy
Smith, Miss Geraldine (Morecambe & Lunesdale)


Mandelson, Rt Hon Peter



Marsden, Gordon (Blackpool S)

Smith, Jacqui (Redditch)


Marsden, Paul (Shrewsbury)
Smith, John (Glamorgan)


Marshall, David (Shettleston)
Smith, Sir Robert (W Ab'd'ns)


Marshall, Jim (Leicester S)
Soley, Clive






Southworth, Ms Helen
Twigg, Derek (Halton)


Spellar, John
Twigg, Stephen (Enfield)


Squire, Ms Rachel
Tyler, Paul


Starkey, Dr Phyllis
Vis, Dr Rudi


Steinberg, Gerry
Walley, Ms Joan


Stewart, Ian (Eccles)
Ward, Ms Claire


Stinchcombe, Paul
Wareing, Robert N


Stoate, Dr Howard
Watts, David


Strang, Rt Hon Dr Gavin
Webb, Steve


Stringer, Graham
White, Brian


Stuart, Ms Gisela
Whitehead, Dr Alan


Stunell, Andrew
Wicks, Malcolm


Sutcliffe, Gerry
Williams, Rt Hon Alan (Swansea W)


Taylor, Rt Hon Mrs Ann (Dewsbury)




Williams, Alan W (E Carmarthen)


Taylor, Ms Dari (Stockton S)
Williams, Mrs Betty (Conwy)


Taylor, David (NW Leics)
Willis, Phil


Temple-Morris, Peter
Wills, Michael


Thomas, Gareth R (Harrow W)
Winnick, David


Thomas, Simon (Ceredigion)
Winterton, Ms Rosie (Doncaster C)


Timms, Stephen
Woodward, Shaun


Tipping, Paddy
Woolas, Phil



Todd, Mark
Wray, James


Tonge, Dr Jenny
Wright, Anthony D (Gt Yarmouth)


Trickett, Jon
Wright, Tony (Cannock)


Turner, Dennis (Wolverh'ton SE)



Turner, Dr Desmond (Kemptown)
Tellers for the Ayes:


Turner, Dr George (NW Norfolk)
Mr. Don Touhig and


Turner, Neil (Wigan)
Mr. Ian Pearson.




NOES


Ainsworth, Peter (E Surrey)
Hamilton, Rt Hon Sir Archie


Amess, David
Hammond, Philip


Arbuthnot, Rt Hon James
Hayes, John


Atkinson, Peter (Hexham)
Heald, Oliver


Baldry, Tony
Heathcoat-Amory, Rt Hon David


Beggs, Roy
Horam, John


Bercow, John
Howard, Rt Hon Michael


Beresford, Sir Paul
Howarth, Gerald (Aldershot)


Blunt, Crispin
Hunter, Andrew


Body, Sir Richard
Jackson, Robert (Wantage)


Boswell, Tim
Jenkin, Bernard


Brady, Graham
Johnson Smith, Rt Hon Sir Geoffrey



Brazier, Julian



Brooke, Rt Hon Peter
Key, Robert


Browning, Mrs Angela
Kirkbride, Miss Julie


Burns, Simon
Laing, Mrs Eleanor


Butterfill, John
Lait, Mrs Jacqui


Cash, William
Lansley, Andrew


Chapman, Sir Sydney (Chipping Barnet)
Leigh, Edward



Letwin, Oliver


Chope, Christopher
Lewis, Dr Julian (New Forest E)


Clark, Dr Michael (Rayleigh)
Lidington, David


Collins, Tim
Lloyd, Rt Hon Sir Peter (Fareham)


Cormack, Sir Patrick
Loughton, Tim


Cran, James
Lyell, Rt Hon Sir Nicholas


Curry, Rt Hon David
McCrea, Dr William


Davies, Quentin (Grantham)
McIntosh, Miss Anne


Davis, Rt Hon David (Haltemprice)
Maclean, Rt Hon David


Day, Stephen
McLoughlin, Patrick


Duncan, Alan
Malins, Humfrey


Evans, Nigel
Maples, John


Fabricant, Michael
Moss, Malcolm


Fallon, Michael
Nicholls, Patrick


Forth, Rt Hon Eric
Norman, Archie


Fowler, Rt Hon Sir Norman
O'Brien, Stephen (Eddisbury)


Fox, Dr Liam
Ottaway, Richard


Gale, Roger
Page, Richard


Garnier, Edward
Pickles, Eric


Gibb, Nick
Portillo, Rt Hon Michael


Gill, Christopher
Prior, David


Gillan, Mrs Cheryl
Randall, John


Gorman, Mrs Teresa
Redwood, Rt Hon John


Gray, James
Robertson, Laurence (Tewk'b'ry)


Greenway, John
Roe, Mrs Marion (Broxbourne)


Grieve, Dominic
St Aubyn, Nick





Sayeed, Jonathan
Viggers, Peter


Shephard, Rt Hon Mrs Gillian
Walter, Robert


Shepherd, Richard
Waterson, Nigel


Simpson, Keith (Mid-Norfolk)
Whitney, Sir Raymond


Smyth, Rev Martin (Belfast S)
Whittingdale, John


Spelman, Mrs Caroline
Widdecombe, Rt Hon Miss Ann


Spring, Richard
Wilkinson, John


Stanley, Rt Hon Sir John
Willetts, David


Streeter, Gary
Wilshire, David


Swayne, Desmond
Winterton, Mrs Ann (Congleton)


Syms, Robert
Winterton, Nicholas (Macclesfield)


Taylor, Ian (Esher & Walton)
Yeo, Tim


Taylor, Rt Hon John D (Strangford)
Young, Rt Hon Sir George


Taylor, Sir Teddy



Townend, John
Tellers for the Noes:


Tredinnick, David
Mr. Peter Luff and


Trend, Michael
Mr. Geoffrey Clifton-Brown.

Question accordingly agreed to.

Order for Third Reading read.

Mr. Speaker: Before I call the Minister to speak on Third Reading, I should announce that I have selected the amendment in the name of the Liberal Democrat party.

Mr. Edward Leigh: On a point of order, Mr. Speaker Do you think it adequate for the mother of Parliaments to give a Third Reading of just 15 minutes to an important Bill?

Mr. Speaker: Order. It must be adequate because I am proceeding according to the rules of the House. I call the Minister to speak.

Mr. Denham: I beg to move, That the Bill be now read the Third time.
Had the hon. Member for Gainsborough (Mr. Leigh) been here earlier, he would have heard his colleagues argue that an hour was far too long to spend on Third Reading of a Bill of this sort. The House would welcome a little bit of co-ordination by Opposition Members.
As we approach the end of the Commons stage on the Bill, I want to make a few points. The Bill is vital to implement the NHS plan. As a Government, we inherited a fragmented and under-resourced NHS; buildings were crumbling and there were too few staff. We have already acted to end the internal market, to get the biggest ever hospital building programme under way, to set up primary care groups and trusts and to expand the training of staff. We are now seeing unprecedented investment in the NHS which, however, must be investment for modernisation. The measures in the Bill make sure that that will happen.
First, it is a decentralising and devolving Bill, which underpins the principle of earned autonomy for the best run parts of the health service, together with the principles of less performance; management and greater financial freedom. It gives new powers to the NHS and local councils to work together at local level. They already have partnership powers; row they have the ability to create new joint organisations and a new level of partnership to provide a seamless care service for the elderly, the mentally ill and children. Those powers have been widely welcomed and sought. Unfortunately, not all right hon. and hon. Members have taken a close interest in the Bill, but it is no less important for that.

Dr. Lynne Jones: Will my right hon. Friend give way?

Mr. Denham: If my hon. Friend will forgive me, I should like to make a little progress.
As we have just discussed, the Bill provides more power for patients and increased democratic local scrutiny. It also enables us to tackle variations. The best of the NHS is extremely good, but the variations in the service are too wide. As we develop earned autonomy for the best parts of the system, we have more effective means to support and intervene in any part of the system in which performance is poor or trusts are failing. The Bill underlines the new performance management system and the performance fund that will be worth £250 million in two or three years' time. It gives us the power, if needed as a last resort, to tackle failing trusts.
The Bill gives us the power to tackle variations in primary care. The new unified budget will make it easier for health authorities to determine the expansion of GP numbers, attract more GPs to deprived areas and enable them to work in better premises. The Bill makes possible a new partnership to invest £1 billion in primary care premises and one-stop primary centres, starting in deprived areas. It therefore helps our commitment to tackle health inequalities.
The Bill also enables us to protect the quality of patient services. All GPs will be on health authority lists; there will be a new system of suspension, removal and appeal which means that, in the small number of cases in which it is needed, there will be a faster and more effective system to safeguard patients and a fairer system for GPs. It enables us to hour the agreement with the British Medical Association that, as GPs move on to lists, all of them will be able to join the NHS pension scheme. It will take some months to get the lists into place, but our aim is to backdate them to April this year. We rightly extend the list system to other health professionals.
The Bill protects patients and improves the quality of care in other ways, for example, by ensuring tight controls over the use of patient information and by enabling patients to have more information about their own personal care. The Bill backs innovation: it provides for new ways of providing pharmaceutical services, establishes new groups of health professionals able to prescribe prescription drugs, and creates new powers to ensure that the NHS can benefit properly and fairly from its own research and innovation.
The Bill brings new fairness to health care for the elderly. For the first time ever, NHS nursing care will be free wherever it is delivered. It ends the means test of health care in nursing homes. That is a huge step forward, which goes with the investment by 2004–05 of £1 billion in new and improved health and social care services for the elderly.
That means turning our back on Tory privatisation, on the cuts that they promised in social care, and on the cuts that they promised in health care to make up for the money that they would not raise from tobacco, and the money that they would waste on subsidising private health insurance. It reverses Tory plans to make people pay for hip operations, knee operations, cataract operations and hernias. It is an important Bill, which underpins the Government's commitment to the long-term future and modernisation of the NHS.

Dr. Fox: I begin by correcting the first of a remarkable list of inaccuracies in the Minister's speech. He said that we did not want as much time as was allocated for Third

Reading. The point that we made at the beginning of the day was that we had very little time for all the remaining stages of the Bill, including the Government's new clauses and more than 120 amendments. It is a sad reflection on the new procedure in the House that we have been able to give so little consideration to the remaining stages. The one correct thing that the Minister said was that the Bill was extremely important.
The Bill must be judged by whether it will improve the overall health care in this country and the running of the national health service. Almost any medical or nursing group that we speak to throughout the country speaks about morale in the NHS being at an all-time low, more people leaving the service than ever before, more doctors taking early retirement than ever before—

Maria Eagle: The hon. Gentleman is talking down the NHS again.

Dr. Fox: The hon. Lady says that I am talking the service down. Her Government have been in charge of the NHS for the past four years. More people are leaving the service than ever before. That is one thing for which she cannot blame the previous Government. This is the fourth winter that the Government have been in control of the health service, where morale among staff is clearly very poor. I wonder when the Government will take responsibility for anything that they are getting wrong.
Increased numbers of people are waiting to be treated in the service. The Government talk about the number by which they have reduced the in-patient waiting list. The Minister deprecates the private sector, but it is worth pointing out that since the Government came to office, 450,000 people have left the waiting list of their own volition to purchase treatment in the private sector with their savings. Had it not been for people being forced to use their savings by the waiting times overseen by the Government, the waiting lists would have risen by even more than they have.
Notwithstanding that huge reduction, as a result of the fact that people have been willing to pay, often for life-saving treatments, with their life savings, the total number of patients waiting in our system has gone up, if one adds together the in-patients and the waiting list for the waiting list, which has soared since the Government came to power.
Perhaps worse than that are the distorted priorities in the system. In the short time available to me, I will not go over the catalogue of horrors that we have heard in recent debates and which have been raised in the House during Question Time. When surgeons are asked to cancel waiting lists for surgery for cancer patients so that they can treat more minor cases, we must wonder about the ethical basis for our system. Under the Government's bizarre and distorted waiting list initiative, we have reached the point when we are debating whether to treat the sickest patients first. That is the background to the debate, and the level of distortion that now exists in the system.
Ministers have failed to tackle the most important thing of all—not the number of patients waiting, but what the service does. There is nothing in the Bill about outcome-based targets for a system and a country that has just slipped behind Turkey in life expectancy—down to 19th place in the world. In many priority areas, the NHS


fails to deliver outcomes that we might rightfully expect for the fourth wealthiest nation in the world, yet patients with in-growing toe nails and impacted wisdom teeth are being removed from the waiting list simply to make the figures look better for Ministers. That is a disgraceful way to run a service.
Against that background, we are faced with the NHS plan and the Bill. The NHS plan is not a plan in the sense in which most people would understand that word. It is more of a wish list, as we see when we consider some of its particular aspects and scrutinise them in detail. Such aspects include the number of staff required. Medical bodies such as the British Medical Association and the royal colleges tell us not only that the Bill does nothing for the provision of staff, but that the numbers are greatly underestimated in the first place.
The Minister tells us that the Bill is a decentralising measure. He has many talents, but he has only recently turned his hand to comedy. The Bill could not be described as decentralising by any stretch of the imagination. It will reinforce all the micro-management tendencies of the current Government, who genuinely believe that a service that employs a million people can be managed from behind a single Minister's desk in Whitehall. There is constant interference with management and the Department is continually distributing circulars that make it impossible for anyone to set budgets for any length of time and which force those in NHS management to go chasing after packets of money for which they must compete by investing huge amounts of their time and energy. We need depoliticisation and decentralisation, but the Bill gives us increased centralisation.
That is not to say that the Opposition do not welcome some parts of the Bill. We welcome the extension of nursing care, which the Minister mentioned. We also welcome proper control of locums. From my personal experience, I think that that is long overdue in the NHS. We do not pretend for a minute that every aspect of the Bill is undesirable, but three major issues make it completely unpalatable.
The first issue is the abolition of community health councils, which we have recently addressed. Let me make the Opposition's position perfectly clear. We think that the new clauses introduced on Report will reduce the damage caused by the abolition of CHCs, but we do not accept them because we do not accept that policy. We will continue to press for retention and reform of CHCs as the Bill proceeds through the House of Lords. I believe that we will have the support of Liberal Democrats in the other place in carrying that process forward. There is no doubt that the abolition of CHCs is a completely unacceptable policy, as it removes an independent voice for patients, as well as their ability to use a single point of access into the system.
None of the questions that we asked earlier were answered. We had no answer about cost or about what would happen to the staff or to confidential information. We have debated the ownership and confidentiality of patient information, and have considered where it should rest. A huge volume of information about patients is contained in the records of CHCs throughout the country. Having spent time debating those matters, however, we have reached Third Reading and we do not yet know

where that information will go. As it may contain complaints about specific doctors or hospitals, it could potentially return to those doctors or hospitals.

Mr. David Maclean: My hon. Friend's point about CHCs worries us all, but what concerns the doctors and surgeons in my constituency and those of other Opposition Members is the fact that the Government are taking away their clinical freedom. Will he give an absolute assurance that after the election, when he is in charge of health policy and the Conservative party is in government, the distorted priorities imposed from the centre by Labour Ministers will be swept away and doctors will have the freedom to treat the sickest first?

Mr. Paul Tyler: On a point of order, Mr. Speaker. I beg to move the amendment standing in the name of Liberal Democrat Members.

Mr. Speaker: I cannot allow that on a point of order. The hon. Member for Woodspring (Dr. Fox) is on his feet and has the Floor.

Dr. Fox: At least two hon. Members who have spoken today would benefit from reading "Erskine May". You mentioned one earlier, Mr. Speaker; I offer you another candidate.
I give my right hon. Friend the Member for Penrith and The Border (Mr. Maclean) the assurance that he seeks. In a few months, when the electorate have decided that they need a change of Government, we shall return to a system of proper clinical priorities that treats the sickest patients first.
Another unacceptable aspect of the Bill is the interventionism in hiring and firing trust board members, and the ability of the Secretary of State to set terms and conditions of employment. That will allow greater manipulation of and further controls over information for which clause 62 provides. The Secretary of State will be able to perform unacceptable actions, including publishing patient information if he chooses to do that.

It being Ten o'clock, MR. SPEAKER put the Question already proposed from the Chair, pursuant to Order [7 November and this day].

Question put, That the Bill be now read the Third time:—

The House divided: Ayes 310, Noes 168.

Division No. 128]
[10 pm


AYES


Adams, Mrs Irene (Paisley N)
Begg, Miss Anne


Ainger, Nick
Bell, Stuart (Middlesbrough)


Ainsworth, Robert (Cov'try NE)
Benn, Hilary (Leeds C)


Anderson, Rt Hon Donald (Swansea E)
Bennett, Andrew F



Benton, Joe


Armstrong, Rt Hon Ms Hilary
Bermingham, Gerald


Ashton, Joe
Berry, Roger


Atkins, Charlotte
Best, Harold


Austin, John
Betts, Clive


Bailey, Adrian
Blears, Ms Hazel


Banks, Tony
Blizzard, Bob


Barnes, Harry
Borrow, David


Barron, Kevin
Bradshaw, Ben


Battle, John
Brinton, Mrs Helen


Bayley, Hugh
Brown, Russell (Dumfries)


Beard, Nigel
Browne, Desmond


Beckett, Rt Hon Mrs Margaret
Buck, Ms Karen






Burden, Richard
Griffiths, Jane (Reading E)


Burgon, Colin
Griffiths, Nigel (Edinburgh S)


Byers, Rt Hon Stephen
Griffiths, Win (Bridgend)


Campbell, Mrs Anne (C'bridge)
Grocott, Bruce


Campbell, Ronnie (Blyth V)
Grogan, John


Campbell-Savours, Dale
Gunnell, John


Cann, Jamie
Hall, Mike (Weaver Vale)


Caplin, Ivor
Hamilton, Fabian (Leeds NE)


Caton, Martin
Hanson David


Cawsey, Ian
Harman, Rt Hon Ms Harriet


Chapman, Ben (Wirral S)
Henderson, Doug (Newcastle N)


Chaytor, David
Henderson, Ivan (Harwich)


Clapham, Michael
Hendrick, Mark


Clark, Rt Hon Dr David (S Shields)
Hepburn, Stephen


Clark, Paul (Gillingham)
Heppell, John


Clarke, Charles (Norwich S)
Hesford, Stephen


Clarke, Eric (Midlothian)
Hewitt, Ms Patricia


Clarke, Rt Hon Tom (Coatbridge)
Hinchliffe, David


Clarke, Tony (Northampton S)
Hodge, MS Margaret


Clelland, David
Hope, Phil


Coaker, Vernon
Hopkins, Kelvin


Coffey, Ms Ann
Howarth, George (Knowsley N)


Cohen, Harry
Howells, Dr Kim


Coleman, Iain
Hoyle, Lindsay


Colman, Tony
Hughes, Ms Beverley (Stretford)


Connarty, Michael
Humble, Mrs Joan


Cooper, Yvette
Hutton, John


Corbett, Robin
Iddon, Dr Brian


Corbyn, Jeremy
Illsley, Eric


Cousins, Jim
Jackson, Ms Glenda (Hampstead)


Cox, Tom
Jackson, Helen (Hillsborough)


Cranston, Ross
Jamieson, David


Crausby, David
Jenkins, Brian


Cryer, John (Hornchurch)
Johnson, Alan (Hull W & Hessle)


Cummings, John
Jones, Mrs Fiona (Newark)


Cunningham, Jim (Cov'try S)
Jones, Helen (Warrington N)


Cunningham, Ms Roseanna (Perth)
Jones, Ms Jenny (Wolverh'ton SW)


Darling, Rt Hon Alistair
Jones, Jon Owen (Cardiff C)


Darvill, Keith
Jones, Dr Lynne (Selly Oak)


Davey, Valerie (Bristol W)
Jones, Martyn (Clwyd S)


Davidson, Ian
Jowell, Ftt Hon Ms Tessa


Davies, Rt Hon Denzil (Llanelli)
Joyce, Eric


Davies, Geraint (Croydon C)
Kaufman, Rt Hon Gerald


Davis, Rt Hon Terry (B'ham Hodge H)
Keeble, Ms Sally



Keen, Alan (Feltham & Heston)


Dawson, Hilton
Keen, Ann (Brentford & Isleworth)


Denham, Rt Hon John
Kemp, Fraser


Dismore, Andrew
Kidney, David


Dobbin, Jim
Kilfoyle, Peter


Dobson, Rt Hon Frank
King, Andy (Rugby & Kenilworth)


Donohoe, Brian H
Kumar, Dr Ashok


Doran, Frank
Ladyman, Dr Stephen


Dowd, Jim
Lammy, David


Drew, David
Lawrence, Mrs Jackie


Dunwoody, Mrs Gwyneth
Laxton, Bob


Eagle, Angela (Wallasey)
Lepper, David


Eagle, Maria (L'pool Garston)
Leslie Christopher


Edwards, Huw
Levitt, Tom


Efford, Clive
Lewis, Ivan (Bury S)


Ellman, Mrs Louise
Liddell, Rt Hon Mrs Helen


Ennis, Jeff
Linton, Martin


Etherington, Bill
Lock, David



Fisher, Mark
Love, Andrew


Fitzpatrick, Jim
McAvoy, Thomas


Fitzsimons, Mrs Lorna
McCabe, Steve


Flint, Caroline
McCartney, Rt Hon Ian (Makerfield)


Flynn, Paul



Foster, Rt Hon Derek
McDonagh, Siobhain


Foulkes, George
Macdonald, Calum


Galloway, George
McDonnell, John


George, Rt Hon Bruce (Walsall S)
McGuire, Mrs Anne


Gerrard, Neil
McIsaac, Shona


Gibson, Dr Ian
Mackinlay, Andrew


Gilroy, Mrs Linda
McNamara Kevin


Golding, Mrs Llin
McNulty, Tony





MacShane, Denis
Salter, Martin


Mactaggart, Fiona
Sarwar, Mohammad


McWalter, Tony
Savidge, Malcolm


McWilliam, John
Sawford, Phil


Mahon, Mrs Alice
Sedgemore, Brian


Mallaber, Judy
Sheldon, Rt Hon Robert


Mandelson, Rt Hon Peter
Shipley, Ms Debra


Marsden, Gordon (Blackpool S)
Singh, Marsha


Marsden, Paul (Shrewsbury)
Skinner, Dennis


Marshall, David (Shettleston)
Smith, Rt Hon Andrew (Oxford E)


Marshall, Jim (Leicester S)
Smith, Miss Geraldine (Morecambe & Lunesdale)


Martlew, Eric



Meacher, Rt Hon Michael
Smith, Jacqui (Redditch)


Meale, Alan
Smith, John (Glamorgan)


Merron, Gillian
Soley, Clive


Michael, Rt Hon Alun
Southworth, Ms Helen


Michie, Bill (Shef'ld Heeley)
Spellar, John


Milburn, Rt Hon Alan
Squire, Ms Rachel


Miller, Andrew
Starkey, Dr Phyllis


Mitchell, Austin
Steinberg, Gerry


Moffatt, Laura
Stewart, Ian (Eccles)


Morgan, Ms Julie (Cardiff N)
Stinchcombe, Paul


Morris, Rt Hon Ms Estelle (B'ham Yardley)
Stoate, Dr Howard



Strang, Rt Hon Dr Gavin


Morris, Rt Hon Sir John (Aberavon)
Stringer, Graham



Stuart, Ms Gisela


Mullin, Chris
Sutcliffe, Gerry


Murphy, Denis (Wansbeck)
Taylor, Rt Hon Mrs Ann (Dewsbury)


Murphy, Jim (Eastwood)



Murphy, Rt Hon Paul (Torfaen)
Taylor, Ms Dari (Stockton S)


Naysmith, Dr Doug
Taylor, David (NW Leics)


Norris, Dan
Temple-Morris, Peter


O'Brien, Bill (Normanton)
Thomas, Gareth R (Harrow W)


O'Hara, Eddie
Timms, Stephen


Olner, Bill
Tipping, Paddy


O'Neill, Martin
Todd, Mark


Organ, Mrs Diana
Touhig, Don


Pearson, Ian
Trickett, Jon


Pickthall, Colin
Turner, Dennis (Wolverh'ton SE)


Pike, Peter L
Turner, Dr Desmond (Kemptown)


Pond, Chris
Turner, Dr George (NW Norfolk)


Pope, Greg
Turner, Neil (Wigan)


Pound, Stephen
Twigg, Derek (Halton)


Powell, Sir Raymond
Twigg, Stephen (Enfield)


Prentice, Ms Bridget (Lewisham E)
Vaz, Keith


Prentice, Gordon (Pendle)
Vis, Dr Rudi


Prescott, Rt Hon John
Walley, Ms Joan


Primarolo, Dawn
Ward, Ms Claire


Prosser, Gwyn
Wareing, Robert N


Purchase, Ken
Watts, David


Quin, Rt Hon Ms Joyce
White Brian


Quinn, Lawrie
Whitehead, Dr Alan


Rammell, Bill
Wicks, Malcolm


Raynsford, Nick
Williams, Rt Hon Alan (Swansea W)


Reed, Andrew (Loughborough)
Williams, Alan W (E Carmarthen)


Robertson, John (Glasgow Anniesland)
Williams, Mrs Betty (Conwy)



Wills, Michael


Robinson, Geoffrey (Cov'try NW)
Winnick, David


Rogers, Allan
Winterton, Ms Rosie (Doncaster C)


Rooker, Rt Hon Jeff
Woodward, Shaun


Rooney, Terry
Woolas, Phil


Ross, Ernie (Dundee W)
Wray, James


Rowlands, Ted
Wright, Anthony D (Gt Yarmouth)


Roy, Frank
Wright, Tony (Cannock)


Ruane, Chris
Wyatt, Derek


Ruddock, Joan



Russell, Ms Christine (Chester)
Tellers for the Ayes:


Ryan, Ms Joan
Mr. Kevin Hughes and


Salmond, Alex
Mr. Graham Allen.




NOES


Ainsworth, Peter (E Surrey)
Ashdown, Rt Hon Paddy


Allan, Richard
Atkinson, Peter (Hexham)


Amess, David
Baker, Norman


Ancram, Rt Hon Michael
Baldry, Tony


Arbuthnot, Rt Hon James
Ballard, Jackie






Beggs, Roy
Johnson Smith, Rt Hon Sir Geoffrey


Beith, Rt Hon AJ



Bell, Martin (Tatton)
Keetch, Paul


Bercow, John
Key, Robert


Beresford, Sir Paul
Kirkbride, Miss Julie


Blunt, Crispin
Kirkwood, Archy


Body, Sir Richard
Laing, Mrs Eleanor


Boswell, Tim
Lait, Mrs Jacqui


Bottomley, Peter (Worthing W)
Lansley, Andrew


Bottomley, Rt Hon Mrs Virginia
Leigh, Edward


Brady, Graham
Letwin, Oliver


Brake, Tom
Lewis, Dr Julian (New Forest E)


Brand, Dr Peter
Lidington, David


Brazier, Julian
Livsey, Richard


Breed, Colin
Lloyd, Rt Hon Sir Peter (Fareham)


Brooke, Rt Hon Peter
Loughton, Tim


Browning, Mrs Angela
Lyell, Rt Hon Sir Nicholas


Bruce, Malcolm (Gordon)
McCrea, Dr William


Burnett, John
McIntosh, Miss Anne


Burns, Simon
MacKay, Rt Hon Andrew


Burstow, Paul
Maclean, Rt Hon David


Butterfill, John
McLoughlin, Patrick


Cash, William
Malins, Humfrey


Chapman, Sir Sydney (Chipping Barnet)
Maples, John



Mates, Michael



Chope, Christopher
Michie, Mrs Ray (Argyll & Bute)


Clark, Dr Michael (Rayleigh)
Moore, Michael


Clark, Rt Hon Kenneth (Rushcliffe)
Moss, Malcolm



Nicholls, Patrick


Collins, Tim
Norman, Archie


Cormack, Sir Patrick
Oaten, Mark


Cotter, Brian
O'Brien, Stephen (Eddisbury)


Cran, James
Öpik, Lembit


Curry, Rt Hon David
Ottaway, Richard


Davey, Edward (Kingston)
Page, Richard


Davies, Quentin (Grantham)
Pickles, Eric


Davis, Rt Hon David (Haltemprice)
Portillo, Rt Hon Michael


Day, Stephen
Prior, David


Duncan, Alan
Randall, John


Emery, Rt Hon Sir Peter
Redwood, Rt Hon John


Evans, Nigel
Rendel, David


Fabricant, Michael
Robertson, Laurence (Tewk'b'ry)


Fallon, Michael
Roe, Mrs Marion (Broxbourne)


Feam, Ronnie
Russell, Bob (Colchester)


Flight, Howard
St Aubyn, Nick


Forth, Rt Hon Eric
Sanders, Adrian


Fowler, Rt Hon Sir Norman
Sayeed, Jonathan


Fox, Dr Liam
Shephard, Rt Hon Mrs Gillian


Gale, Roger
Shepherd, Richard


Garnier, Edward
Simpson, Keith (Mid-Norfolk)


George, Andrew (St Ives)
Smith, Sir Robert (W Ab'd'ns)


Gibb, Nick
Smyth, Rev Martin (Belfast S)


Gidley, Sandra
Soames, Nicholas


Gill, Christopher
Spelman, Mrs Caroline


Gillan, Mrs Cheryl
Spring, Richard


Gorman, Mrs Teresa
Stanley, Rt Hon Sir John


Gray, James
Steen, Anthony


Greenway, John
Streeter, Gary


Grieve, Dominic
Stunell, Andrew


Gummer, Rt Hon John
Swayne, Desmond


Hamilton, Rt Hon Sir Archie
Syms, Robert


Hammond, Philip
Taylor, Ian (Esher & Walton)


Hancock, Mike
Taylor, Rt Hon John D (Strangford)


Harris, Dr Evan
Taylor, Sir Teddy


Harvey, Nick
Thomas, Simon (Ceredigion)


Hayes, John
Tonge, Dr Jenny


Heald, Oliver
Townend, John


Heath, David (Somerton & Frome)
Tredinnick, David


Heathcoat-Amory, Rt Hon David
Trend, Michael


Horam, John
Tyler, Paul


Howard, Rt Hon Michael
Viggers, Peter


Howarth, Gerald (Aldershot)
Walter, Robert


Hughes, Simon (Southwark N)
Waterson, Nigel



Hunter, Andrew
Webb, Steve


Jackson, Robert (Wantage)
Whitney, Sir Raymond


Jenkin, Bernard
Whittingdale, John






Widdecombe, Rt Hon Miss Ann
Yeo, Tim


Wilkinson, John
Young, Rt Hon Sir George


Willetts, David



Willis, Phil
Tellers for the Noes:



Wilshire, David
Mr. Geoffrey Clifton-Brown


Winterton, Mrs Ann (Congleton)
and


Winterton, Nicholas (Macclesfield)
Mr. Peter Luff.

Question accordingly agreed to.

Bill read the Third time, and passed.

DELEGATED LEGISLATION

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

AGRICULTURE

That the Pig Industry Restructuring (Capital Grant) Scheme 2001 (S.I., 2001, No. 251) dated 1st February 2001, a copy of which was laid before this House on 1st February, be approved.—[Mrs. McGuire.]

Question agreed to.

BUSINESS OF THE HOUSE

Motion made,

That Standing Order No. 145 (Liaison Committee) be amended as follows:

Line 31, at end add—
'() The committee shall have power to appoint a sub-committee, which shall have power to send for persons, papers and records, to sit notwithstanding any adjournment of the House, and to report to the committee from time to time.
() The committee shall have power to report from time to time the minutes of evidence taken before the sub-committee.
() The quorum of the sub-committee shall be three.'.—[Mrs. McGuire.]

Hon. Members: Object.

SCIENCE AND TECHNOLOGY COMMITTEE

Order read for resuming adjourned debate on Question [31 January],

That the Select Committee on Science and Technology shall have leave to meet concurrently with any committee of the Lords on science and technology or any sub-committee thereof, for the purpose of deliberating or taking evidence, and to communicate to any such committee its evidence or any other documents relating to matters of common interest—[Mrs. McGuire.]

Hon. Members: Object.

SITTINGS IN WESTMINSTER HALL

Order read for resuming adjourned debate on Question [23 January],

That, following the Order [20th November 2000], Mr. Nicholas Winterton, Mr. John McWilliam, Mr. Barry Jones and Frank Cook be appointed to act as additional Deputy Speakers at sittings in Westminster Hall during this Session—[Mrs. McGuire.]

Hon. Members: Object.

SELECT COMMITTEES (JOINT MEETINGS)

Motion made,

That Standing Order No. 152 (Select committees related to government departments) be amended as follows:

Line 40, before the word 'European' insert the words 'Environmental Audit Committee or with the'.

Line 50, before the word 'European' insert the words 'Environmental Audit Committee or with the'.

Line 52, at the end insert the words:—
'(4A) notwithstanding paragraphs (2) and (4) above, where more than two committees or sub-committees appointed under this order meet concurrently in accordance with paragraph (4)(e) above, the quorum of each such committee or sub-committee shall be two.'—[Mrs. McGuire.]

Hon. Members: Object.

LANGUAGE OF PARLIAMENTARY PROCEEDINGS

Motion made,

That—

(1) this House approves the First Report from the Procedure Committee, Session 2000–01 (HC 47); and

(2) the Resolution of 5th June 1996 on the Language of Parliamentary Proceedings be amended accordingly by inserting, after the word 'Wales,', the words 'and at Westminster in respect of Select Committees'.—[Mrs. McGuire.]

Hon. Members: Object.

PETITION

Community Transport Schemes

Mr. Steve Webb: I am grateful for the chance to present a petition on behalf of more than 2,000 of my constituents. It was collected on the streets of Thornbury and Yate and in the Gazette newspaper on behalf of the community transport schemes in my area. Community transport schemes have been a great success in recent years, but they are now threatened and could cease within months.
The petition states:
The Humble Petition of the citizens of South Gloucestershire sheweth:
the great value which is attached to the work of South Gloucestershire Community Transport schemes.
Wherefore your petitioners pray that your honourable House will take such measures as lie within its power to end the uncertainty over their future funding and to make an immediate commitment to supporting such schemes over the long term.
And your petitioners, as in Duty bound, will ever pray etc.
To lie upon the Table.

Endometriosis

Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]

Mr. John McDonnell: It is a cruel irony that the subject of endometriosis has been timetabled for debate today, on St. Valentine's day. It is ironic because, for many women sufferers of endometriosis, lovemaking can be extremely painful. It is cruel because, for some women, the condition prevents them from bearing the children they so lovingly wish for. I have sought this debate to draw attention to a condition that not only has heart-rending consequences, but is underestimated in its incidence and effects; under-publicised, resulting in widespread ignorance of its symptoms among women and general practitioners alike; and under-resourced, leading to delays in diagnosis, inappropriate treatment and a postcode lottery for patients seeking to gain access to the relevant expertise.
What is endometriosis? It is probably one of the most complex gynaecological conditions, and it is the second most common such condition. It occurs when the endometrium—the cells that line the interior of the uterus—are found in other parts of the body. The endometrium is most commonly misplaced on the outside of the uterus, on the Fallopian tubes, the ovaries, the bowel, the peritoneum—the lining of the pelvis—and elsewhere, usually in the pelvis. Cyclical bleeding of these fragments can lead to chronic pelvic pain and the formation of adhesions and cysts. The symptoms are known to vary widely. This affects the ability to diagnose the condition because of the similarity with the symptoms of other diseases. Symptoms associated with endometriosis include: dysmenorrhoea, or painful bleeding; chronic pelvic pain; deep dyspareunia, or painful sexual intercourse; and infertility.
A recent study by the Northern Endometriosis Centre found that endometriosis causes both disturbing local symptoms and also profound effects on the general health, personal life and well-being of sufferers. Apart from the physical manifestations of this condition, the chronic pain suffered by its victims can place strain on the woman's relationships and career.
A survey by the National Endometriosis Society conducted last year asked whether endometriosis had ever affected women's employment. Some 65 per cent. said yes; 30 per cent. had not been able to keep the same job and 16 per cent. had stopped working. The cost to the economy has yet to be calculated, but must run into hundreds of millions of pounds.
The causes of endometriosis are not known for certain. However, there are several theories, including retrograde menstruation; metaplasia theory, or incorrect cell development; vascular theory, under which endometriosis tissue may travel through the bloodstream; and immune theory, linking the condition to an immune dysfunction. As diagnosis can only be confirmed surgically, it is difficult to establish accurate figures for the incidence of this condition in the UK.
The organisation Women's Health UK suggests that between 3 and 10 per cent. Of women have endometriosis. For women having difficulty conceiving, the figure rises to between 25 and 35 per cent. As more diagnoses are


occurring, we are having to revise our estimates upwards. It is now suggested that between 1.5 million and 2 million women suffer from endometriosis, giving an average of between 500 and 2,000 sufferers in every constituency.
The NES survey demonstrated that, contrary to past belief, the age range of sufferers is across all ages, but there is a high incidence among young women. Some 17 per cent. of endometriosis sufferers were found to be under 16, and 35 per cent. were in the age range of 20 to 29.
The diagnosis of endometriosis is difficult. Its variable presentation and its overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease has contributed to an average eight-year delay between onset and a surgical diagnosis in the UK. For some, the time between onset and diagnosis can be decades.
The surgical procedure of laparoscopy is the standard diagnostic test, but non-invasive diagnostic methods such as ultrasound and magnetic resonance imaging have also become available.
The choice of treatment depends on a number of factors, such as the woman's age and her fertility plans, previous treatments and their effects and the nature and severity of the disease. The most common medical approach is the continuous use of oral contraception. Other approaches include the use of androgen-like drugs and the use of analogues.
Although all these treatments have been shown to provide some control of mild or minimal disease, they each carry a side-effect profile. It is clear that moderate and severe endometriosis cannot be managed by drug therapy alone. For these sufferers, surgery becomes the preferred option. Minimal surgery is commonly by laser. Other forms used are cauterisation, ablation and excision. In the most extreme cases it may be necessary to remove the uterus, ovaries and Fallopian tubes in order to remove all the active disease. Tragically, a significant proportion of women who undergo radical surgery report the recurrence of symptoms.
Given the extent of this condition and the potential severity of its effects, there is a need for a comprehensive programme to address the needs of endometriosis sufferers. For too long there has been no comprehensive response to the disease. Local planning, campaigning and pressure have not contributed to an overall approach—only to a limited approach in particular geographical areas. If men were suffering in this way, I doubt whether we would need today's debate.
First, we need to tackle the level of ignorance about this condition. Widespread ignorance of the condition and its symptoms results in women delaying their first consultation with their general practitioner or health practitioner. In the NES survey, women were asked whether, when they first experienced the symptoms, they thought they were normal. A staggering 46 per cent. said yes; they accepted the pain that came with the condition almost without question. When asked whether they suspected that they might have endometriosis before they sought medical help, 81 per cent. of women said no. That is a reflection of the lack of awareness of the condition, and of the lack of information disseminated about it. When women were asked where they had gained the information about the condition, 54 per cent. said that they

had discovered the information from the media, and only 8 per cent. said they had found out from official sources, medical leaflets, and so on.
Unfortunately, some women's conditions are still veiled in stigma, and this condition can be one. It can lead to difficulties of disclosure, anxieties and distress, especially among girls and young women. We need a national programme to raise awareness among the general public and among women of all ages, but especially among young women and girls. That would also assist in identifying the needs of women from the range of cultures that make up our multicultural society today. In raising awareness among the general public, we must also facilitate early diagnosis and more effective treatment.
The National Endometriosis Society survey found that in only 9 per cent. Of cases was the condition diagnosed when a sufferer first vent to her doctor and discussed the symptoms. It found that 43 per cent. of women received a non-gynaecological diagnosis, usually of irritable bowel syndrome or appendicitis. A further 11 per cent. were told that they were suffering from painful periods, and 15 per cent. were told that there was nothing wrong.
We desperately need a new initiative to reduce delays in diagnosis and ensure that GPs are more informed about recognising the disease. That could be done by featuring the condition more prominently in medical training, and by emphasising it in in-service training and in information provided to GPs.
Greater recognition needs to be given to specialists already working in field, but we also need to establish a wider base of expertise among primary carers. That could be an ideal area in which to develop the proposals in the Government's NHS plan for the training of GP specialists. Mentoring could be provided by consultant specialists in particular hospitals around the country, and it might be possible to use distance learning to develop the specialism among those working in the field.
Although some of the world's leading researchers and clinicians in this condition work in this country, access to treatment can depend on which GP a woman encounters and on the area in which she lives. Often, our limited NHS resources are waged by inappropriate treatments and diagnostic delays.
The NES survey asked sufferers which treatments the GP recommended after their first visit. It found that 47 per cent. were given pain killers, 32 per cent. were provided with non-endometriosis-relevant treatment, and 22 per cent. Were prescribed an oral contraceptive—which at least went some way towards some form of treatment. A further 9 per cent. were given antibiotics, while 7 per cent. were recommended to get pregnant and 16 per cent. were given nothing. Among those who saw a specialist regarding their symptoms, 32 per cent. saw a non-endometriosis specialist first, and 25 per cent. of sufferers saw a gynaecologist only after having seen two other specialists. The survey found that 54 per cent. of sufferers were told that there was nothing wrong with them before they were diagnosed.
Those terribly stark statistics demand a response. We need a systematic approach to treating this condition. That should include support and ring-fenced funding for the development of a network of national centres of excellence for endometriosis, capable of providing a range of treatments. We also need a review of the specialist referral procedures to ensure equity of access across the country.
Endometriosis is not an acute disease that generally disappears with treatment. Most women with endometriosis suffer in the long term. It may not be a life-threatening disease, but many sufferers will say that it can destroy a woman's life, and her family life.
Endometriosis sufferers and their families need greater support in coping with, and managing, the condition. The NES has been successful in developing techniques for support and in running self-management courses for endometriosis victims, but that superb provision is limited by lack of funds.
The national society provides a comprehensive range of services to address the unmet needs of patients, and its services are used about 100,000 times a year. It does all that on a shoe-string budget of £200,000. Most of those funds are raised by charitable donation, with limited grants from the Government.
We need to launch a fresh initiative to support the NES in promoting self-management schemes for women with endometriosis, led by lay people. That would follow the Government's lead in placing greater emphasis on patient-centred approaches to illness. At present, endometriosis sufferers feel that they are not at the centre of care, but on the circumference.
It is feared that, as national frameworks for the treatment of acute conditions are rolled out, because endometriosis is not life-threatening it will be ignored. That situation will be reflected in the pharmaceutical industry's priorities in researching and developing other forms of treatment. The severity of the pain of endometriosis sufferers and the scale of suffering by the vast number of women affected means that there is a strong argument for developing a national framework for the treatment of the condition as a matter of urgency.
Is the Minister willing to meet me, a group of my parliamentary colleagues and representatives from the NES to discuss how we might take forward that programme of support for endometriosis sufferers? The issue is too important to too many women for us to ignore their pain. Later this year, on Wednesday 4 July, we will be organising a lobby of Parliament as part of an endometriosis awareness day. At that time I hope that we will be able to report a record of action to give hope to sufferers of this debilitating condition.
Finally, I want to thank and pay tribute to three women. Candice Pires is a brilliant young woman who researched the report that I published on this subject last year. If I can convince her about the future of socialism, I hope that one day she will use her talents in the Chamber. Angela Barnard, from the NES, has doggedly and with courage, determination and commitment ensured that the issue will not be ignored. My constituent Tracey Holliday has, throughout the pain of her condition, worked hard to support other sufferers and to develop the campaign for recognition of the need for the Government to act. Without them, we would not have had the opportunity of this debate tonight. I give them this undertaking: we will not let them down.

The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for Hayes and Harlington (Mr. McDonnell) on securing this debate on endometriosis services. This is a subject in which I know he has a great personal interest

and to which he is devoting considerable time and energy, and I welcome that. I am particularly pleased to have the opportunity to reply to the debate because this is a complex and often ill-understood disease that affects many thousands of women in this country.
Endometriosis is the second most common gynaecological condition in this country, and it affects up to about 2 million women. It is estimated that between 3 and 10 per cent. of women aged between 15 and 45 have endometriosis. In women who have difficulty conceiving, the rate rises to between 25 and 35 per cent.
My hon. Friend has ably described endometriosis and its effects. It is a condition that remains with a woman intermittently throughout the reproductive years of her life. For many women, the continuing recurrent pain and other symptoms make life difficult or even intolerable. The condition can have lasting effects on a woman's self-image, sexuality and fertility. The widespread effects are felt not only by the woman herself but by family and friends trying to cope with the problems that can result. We should not underestimate the importance of endometriosis and the effects that it has on so many people.
Outdated ideas about who is likely to have endometriosis are unfortunately still common. There remains a belief in some quarters that it is the illness of goal-oriented career women over the age of 30. That misconception has now been well and truly disproved. Women in their 20s are increasingly coming forward with endometrial symptoms, and the condition is being diagnosed and treatment offered. The sooner the condition is diagnosed and treated, the better, because that can prevent women from experiencing unnecessary suffering and developing more complex problems that will need more radical treatment.
Endometriosis is not always easy to diagnose because it can mimic or even accompany other causes of abdominal pain. That leads to many women facing uncomfortable, difficult and frustrating delays in diagnosis. Laparoscopy is the only sure way of diagnosing endometriosis. Often in the past, and even today, the pain experienced by sufferers has been dismissed as psychological, while the damage to the pelvic organs continues from the condition.
It is important that at all stages of treatment, medical practitioners discuss the disease and possible treatments fully with the patient. It is vital that each woman understands the options for treatment and understands and agrees with the way in which the condition is handled.
Treatment options can include management of symptoms, medical management of the disease, conservative surgery and radical surgery. Most drug treatments for endometriosis are based on suppressing ovarian activity and hormone release, which abolishes a woman's normal cycle. Generally, such treatments can only suppress endometriosis. I know that many women have found some improvement in their symptoms through using complementary therapies.
For more limited surgery, minimally invasive surgical techniques are increasingly used, allowing a woman to be up and about much sooner following the operation. The radical treatment for endometriosis is a hysterectomy. However, that is appropriate only for women who have completed their families or in cases in which the disease is showing itself in a particularly severe form.


With hysterectomy, it is vital that a woman feels psychologically prepared for the impact of such a radical move.
The Royal College of Obstetricians and Gynaecologists has produced guidelines on the investigation and management of endometriosis. The guidelines bring together the latest knowledge and best practice, based on clinical evidence of the diagnosis and treatment of endometriosis. They also examine options for treatment in the light of presenting symptoms and associated infertility. The guidelines have been distributed to all the royal college's fellows and members, and I welcome that piece of work.
My hon. Friend has raised a series of concerns, issues and proposals. I will be happy to discuss them with him and with any delegation that he chooses to bring. There are many areas in which we could have a positive and constructive discussion about some of his proposals.
My hon. Friend referred to increasing awareness among women about endometriosis. Work on that is already done through the National Endometriosis Society. The Department of Health funds the society by giving it a grant to help with its core costs, and a further grant for employing an information officer. The NES is a long-standing, effective organisation that can target information about endometriosis at relevant audiences. We look forward to continuing the close working relationship with the society over the range of its activities, including raising awareness of this serious condition.
There may be other areas that we can explore. There are, for example, new ways of making information available. A section on endometriosis is now included on the NHS website and there may be other ways, particularly using new technology, that could help to raise awareness. However, I recognise that as we use new technology to raise awareness, we must also be conscious of the limitations that it can have in reaching all parts of society. We must ensure that our means of communication do not perpetuate inequalities.
My hon. Friend mentioned improving the awareness and training of general practitioners. I should certainly be interested to discuss that issue further with him. Options in that respect may include taking advantage of the new technologies, such as the electronic health library. This may be an area in which more work can be done. My hon. Friend will be aware that the NHS plan sets out proposals to expand continuing support and training for doctors and general practitioners across the board. This is certainly an aspect that we would be interested in considering further.
The National Institute for Clinical Excellence is undertaking the referral practice project on advice to GPs about referring common conditions. Endometriosis is not included in the project, but the results of the project may give us a guide on an effective way of offering referral

guidance to GPs on a range of common conditions including endometriosis. That may be another area to explore.
My hon. Friend raised issues about increased specialisation, especially as regards centres of excellence. When we meet, I should be interested to hear further from him on that subject, although I express a note of caution: given that endometriosis is so prevalent, managing and treating it should be part of the routine work of every gynaecology department. We want every area to use the evidence-based approach, to ensure that gynaecologists are following the guidelines issued by their governing body, the Royal College of Obstetricians and Gynaecologists.
My hon. Friend referred to the importance of a patient-centred approach. That is crucial. Right across the board, patients, rightly, expect to receive more information about their health. The NHS must provide that; it must respond to that expectation. It is not enough to leave the provision of information about medical conditions to voluntary organisations and support groups. It is essential that the NHS—whether through consultants, GPs or specialist nurses—can provide patients with the support and information that they need about their condition.
Individual patients need proper discussion of the problems from which they are suffering and of the options that are available. That patient-centred approach and self-management are very much part of the new NHS plan and the work going on at present. Endometriosis is a good example of a condition where that approach can work effectively to the patient's benefit. There are a variety of options for treatment of the condition, but the right treatment will be that which suits a particular woman's own condition and needs. That will be achieved only by the woman discussing her needs fully with her doctor.
There may be further work on self-management which could be pursued. Work is continuing on expert patients groups—supporting patients to help them to manage their own conditions. That may be another aspect that could be developed to provide support for women who suffer from endometriosis.
I welcome the points made by my hon. Friend. I look forward to discussing them further with him and with any delegation that he chooses to bring. More can be done. The RCOG guidelines and the work already under way have improved matters for women suffering from endometriosis. Decades ago, the condition was often less recognised and sufferers experienced many difficulties in having their condition taken seriously; there has certainly been an improvement since then, but I am sure that there is more we can do. When I discuss the matter with my hon. Friend, I hope that we can come up with a constructive way forward.

Question put and agreed to.

Adjourned accordingly at eighteen minutes to Eleven o'clock.